Health and Cancer Rights Act of 1998. In compliance with the Women’s Health Cancer Rights Act of 1998, this Plan provides benefits for mastectomy-related services, including all stages of reconstruc- tion and surgery to achieve symmetry between the breasts, prostheses, and complications resulting from a mastectomy, including lymphedema. See also "Prostheses" in this "Covered Services and Supplies" section for a description of coverage for prostheses. Care in a room of two or more is covered. Benefits for a private room are limited to the Hospital's most common charge for a two-bed room, unless a private room is Medically Necessary. A Member does not have to have been hospitalized to be eligible for Skilled Nursing Facility care. Benefits are limited to the number of days of care stated in "Schedule of Benefits and Copayments," Section 200. Coverage for testing and treatment of phenylketonuria (PKU) includes formulas and special food products that are part of a diet prescribed by a Physician and managed by a licensed health care professional in consultation with a Physician who specializes in the treatment of metabolic disease. The diet must be deemed Medically Necessary to prevent the development of serious physical or mental disabilities or to promote normal development or function.
Health and Cancer Rights Act of 1998. “WHCRA”) If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the WHCRA. For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for:
(i) all stages of reconstruction of the breast on which the mastectomy was performed;
(ii) surgery and reconstruction of the other breast to produce a symmetrical appearance;
(iii) prostheses; and
(iv) treatment of physical complications of the mastectomy, including lymphedema. These benefits will be provided subject to the same Cost Share as applicable to other similar medical and surgical benefits provided under this Contract as is set forth on the Schedule of Enrollee Payments. If you would like more information on WHCRA benefits, you may call the Customer Care Center at 0-000-000-0000.
Health and Cancer Rights Act of 1998. In compliance with the Women’s Health Cancer Rights Act of 1998, this Plan provides benefits for mastectomy-related services, including all stages of reconstruction and surgery to achieve symmetry between the breasts, prostheses, and complications resulting from a mastectomy, including lymphedema. See also "Prostheses" in this "Covered Services and Supplies" section for a description of coverage for prostheses. Professional services, outpatient Hospital facility services and outpatient surgery performed in a Hospital or Outpatient Surgical Center are covered. Professional services performed in the outpatient department of a Hospital (including but not limited to a visit to a Physician, rehabilitation therapy, including physical, occupational and speech therapy, pulmonary rehabilitation therapy and cardiac rehabilitation therapy, laboratory tests, X-rays, radiation therapy and chemotherapy) are subject to the same Copayment which is required when these services are performed at your Physician’s office. Please refer to the "Schedule of Benefits and Copayments - SELECT 1" and "Schedule of Benefits and Copayments - SELECT 2 and SELECT 3" sections for your appropriate Copayment or Coinsurance payment that would apply to your outpatient visit. Copayments for surgery performed in a Hospital or outpatient surgery center may be different than Copay- ments for professional or outpatient Hospital facility services. Please refer to "Outpatient Hospital Services" in the "Schedule of Benefits and Copayments – SELECT 1" and "Schedule of Benefits and Copayments – SELECT 2 and SELECT 3" sections for more information. Coverage for testing and treatment of phenylketonuria (PKU) includes formulas and special food products that are part of a diet prescribed by a Physician and managed by a licensed healthcare professional in consultation with a Physician who specializes in the treatment of metabolic disease. The diet must be deemed Medically Necessary to prevent the development of serious physical or mental disabilities or to promote normal development or function. Coverage is provided only for those costs which exceed the cost of a normal diet.
Health and Cancer Rights Act of 1998. In compliance with the Women’s Health Cancer Rights Act of 1998, this Plan provides benefits for mastectomy- related services, including all stages of reconstruction and surgery to achieve symmetry between the breasts, pros- theses, and complications resulting from a mastectomy, including lymphedema. Prenatal or postnatal office visit............................................................................10% 30% Newborn care office visit (birth through 30 days) .................................................. $0 30% Physician visit to the mother or newborn at a Hospital** ......................................10% 30% Normal delivery, including cesarean section*.......................................................10% 30% Complications of pregnancy, including Medically Necessary abortions* .... See note below See note below Elective abortion ...................................................................................................50% 50% Genetic testing of fetus .........................................................................................10% 30% Circumcision of newborn (birth through 30 days)***.............................................10% 30% The above Copayments and Coinsurances apply to professional services only. Services that are rendered in a Hospital are also subject to the Hospital services Copayment or Coinsurance. Look under the "Inpatient Hospital Services" and "Outpatient Hospital Services" headings to determine any additional Copayments or Coinsurance that may apply. Please refer to pregnancy under the "Covered Services and Supplies" section. Applicable Copayment or Coinsurance requirements apply to any services and supplies required for the treatment of an illness or condition, including but not limited to, complications of pregnancy. For example, if the complication requires an office visit, then the office visit Copayment or Coinsurance will apply.
