CANCER: Women's Health & Cancer Rights Act of 1998

WOMEN’S HEALTH AND CANCER RIGHTS ACT OF 1998 –
IS YOUR COMPANY IN COMPLIANCE?

The Women’s Health and Cancer Rights Act of 1998 was signed into law on October 21, 1998. This law amends the Employee Retirement Income Security Act of 1974 (ERISA) and Public Health Service Act (PHS Act) and applies to all group health plans, their insurance companies and HMOs.

The Women’s Health Act mandates that group health plans that offer coverage for a mastectomy must also provide reconstructive coverage in connection with a mastectomy. This coverage must include reconstruction of the breast on which the mastectomy was performed, surgery and reconstruction of the other breast to create a symmetrical appearance, prostheses, and treatment of physical complications at all stages of the mastectomy, including lymphedemas. These requirements apply to group health plans for plan years beginning on or after October 21, 1998. There may be deductibles or coinsurance requirements for these benefits only if such requirements are consistent with those established for other benefits. The Women’s Health Act also prohibits plans and insurers from denying eligibility to individuals in an effort to avoid the Act. It also prohibits plans and insurers from providing incentives or penalties to doctors in order to induce them to provide care in a manner inconsistent with the Act.

The Women’s Health Act imposes very strict notice requirements. The first notice was due to plan participants by January 1, 1999. This one-time notice must provide a written description of the benefits that the Women’s Health Act requires. We advise that all employers check with their insurance companies to ensure that this notice has been given and to immediately provide such notice if one has not been given. The second notice must also describe the benefits under the Women’s Health Act. This notice must be given to all new enrollees in the plan and furnished annually thereafter. It is important to be sure that your company is in compliance with these notice requirements.