Women’s Health and Cancer Rights Act (WHCRA) The Women’s Health and Cancer Rights Act requires group health plans that provide coverage for mastectomies to also cover reconstructive surgery and prostheses following mastectomies.
The law mandates that a member receiving benefits for a medically necessary mastectomy who elects breast reconstruction after the mastectomy, will receive coverage for:
• reconstruction of the breast on which mastectomy has been performed; • surgery and reconstruction of the other breast to produce a symmetrical appearance; • prostheses; and • treatment of physical complications of all stages of mastectomy, including lymphedemas.
This coverage will be provided in a manner determined in consultation with the attending physician and the patient, and it will be subject to the same annual deductibles and coinsurance provisions as those established for other benefits under the plan. Please call your medical plan using the number on your identification card or contact the employer for more information. Newborn and Mothers’ Health Protection Act Group health plans and health insurance issuers generally may not, under federal law restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following vaginal delivery, or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under federal law, require that a provider obtain authorization from the plan or the issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). Availability of Notice of Privacy Practices The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) requires health plans to protect the confidentiality of your personal health information (“PHI”). HIPAA also requires that health plans maintain privacy notices which provide a complete description of your rights under HIPAA’s privacy rules. The group health plan privacy notice is maintained by your employer. The health insurance plan privacy notices are maintained by the insurance providers. In general, the plans will not use or further disclose PHI except as necessary for treatment, payment, health plan operations and plan administration or as permitted or required by law. Under HIPAA, you have certain rights with respect to your protected health information and the right to file a complaint with the plan or the Secretary of the U.S. Department of Health and Human Services if you believe your rights under HIPAA have been violated. The Village of Pinehurst’s privacy policy can be found on the VOP Intranet here.
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