Federal
breast reconstruction law
SEC. 901. SHORT TITLE.
This title may be cited as the ‘‘Women’s Health and Cancer Rights Act of
1998’’.
SEC. 902. AMENDMENTS TO THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974.
(a) IN GENERAL.—Subpart B of part 7 of subtitle B of title I of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1185 et seq.) is amended by
adding at the end the following new section:
‘‘SEC. 713. REQUIRED COVERAGE FOR RECONSTRUCTIVE SURGERY FOLLOWING
MASTECTOMIES.
‘‘(a) IN GENERAL.—A group health plan, and a health insurance issuer
providing health insurance coverage in connection with a group health plan, that
provides medical and surgical benefits with respect to a mastectomy shall
provide, in a case of a participant or beneficiary who is receiving benefits in
connection with a mastectomy and who elects breast reconstruction in connection
with such mastectomy, coverage for—
‘‘(1) reconstruction of the breast on which the mastectomy has been
performed;
‘‘(2) surgery and reconstruction of the other breast to produce a
symmetrical appearance; and
‘‘(3) prostheses and physical complications all stages of mastectomy,
including lymphedemas; in a manner determined in consultation with the attending
physician and the patient. Such coverage may be subject to annual deductibles
and coinsurance provisions as may be deemed appropriate and as are consistent
with those established for other benefits under the plan or coverage. Written
notice of the availability of such coverage shall be delivered to the
participant upon enrollment and annually thereafter.
‘‘(b) NOTICE.—A group health plan, and a health insurance issuer providing
health insurance coverage in connection with a group health plan shall provide
notice to each participant and beneficiary under such plan regarding the
coverage required by this section in accordance 1078 with regulations
promulgated by the Secretary. Such notice shall be in writing and prominently
positioned in any literature or correspondence made available or distributed by
the plan or issuer and shall be transmitted—
‘‘(1) in the next mailing made by the plan or issuer to the participant or
beneficiary;
‘‘(2) as part of any yearly informational packet sent to the participant or
beneficiary; or
‘‘(3) not later than January 1, 1999; whichever is earlier.
‘‘(c) PROHIBITIONS.—A group health plan, and a health insurance issuer
offering group health insurance coverage in connection with a group health plan,
may not—
‘‘(1) deny to a patient eligibility, or continued eligibility, to enroll or
to renew coverage under the terms of the plan, solely for the purpose of
avoiding the requirements of this section; and
‘‘(2) penalize or otherwise reduce or limit the reimbursement of an
attending provider, or provide incentives (monetary or otherwise) to an
attending provider, to induce such provider to provide care to an individual
participant or beneficiary in a manner inconsistent with this section. 1079
‘‘(d) RULE OF CONSTRUCTION.—Nothing in this section shall be construed to
prevent a group health plan or a health insurance issuer offering group health
insurance coverage from negotiating the level and type of reimbursement with a
provider for care provided in accordance with this section.
‘‘(e) PREEMPTION, RELATION TO STATE LAWS.—
‘‘(1) IN GENERAL.—Nothing in this section shall be construed to preempt
any State law in effect on the date of enactment of this section with respect to
health insurance coverage that requires coverage of at least the coverage of
reconstructive breast surgery otherwise required under this section.
‘‘(2) ERISA.—Nothing in this section shall be construed to affect or
modify the provisions of section 514 with respect to group health plans.’’
(b) CLERICAL AMENDMENT.—The table of contents in section 1 of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1001 note) is amended by
inserting after the item relating to section 712 the following new item:
‘‘Sec. 713. Required coverage reconstructive surgery following
mastectomies.’’.
(c) EFFECTIVE DATES.—
(1) IN GENERAL.—The amendments made by this section shall apply with respect
to plan years beginning on or after the date of enactment of this Act. 1080
(2) SPECIAL RULE FOR COLLECTIVE BARGAINING AGREEMENTS.—In the case of a group
health plan maintained pursuant to 1 or more collective bargaining agreements
between employee representatives and 1 or more employers, any plan amendment
made pursuant to a collective bargaining agreement relating to the plan which
amends the plan solely to conform to any requirement added by this section shall
not be treated as a termination of such collective bargaining agreement.
SEC. 903. AMENDMENTS TO THE PUBLIC HEALTH SERVICE ACT.
(a) GROUP MARKET.—Subpart 2 of part A of title XXVII of the Public Health
Service Act (42 U.S.C. 300gg-4 et seq.) is amended by adding at the end the
following new section:
‘‘SEC. 2706. REQUIRED COVERAGE FOR RECONSTRUCTIVE SURGERY FOLLOWING
MASTECTOMIES.
‘‘The provisions of section 713 of the Employee Retirement Income Security
Act of 1974 shall apply to group health plans, and health insurance issuers
providing health insurance coverage in connection with group health plans, as if
included in this subpart.’’.
(b) INDIVIDUAL MARKET.—Subpart 3 of part B of title XXVII of the Public Health
Service Act (42 U.S.C. 1081 300gg-51 et seq.) is amended by adding at the end
the following new section: ‘‘SEC. 2752. REQUIRED COVERAGE FOR RECONSTRUCTIVE
SURGERY FOLLOWING MASTECTOMIES. ‘‘The provisions of section 2706 shall apply
to health insurance coverage offered by a health insurance issuer in the
individual market in the same manner as they apply to health insurance coverage
offered by a health insurance issuer in connection with a group health plan in
the small or large group market.’’.
(c) EFFECTIVE DATES.—
(1) GROUP PLANS.—
(A) IN GENERAL.—The amendment made by subsection (a) shall apply to group
health plans for plan years beginning on or after the date of enactment of this
Act.
(B) SPECIAL RULE FOR COLLECTIVE BARGAINING AGREEMENTS.—In the case of a group
health plan maintained pursuant to 1 or more collective bargaining agreements
between employee representatives and 1 or more employers, any plan amendment
made pursuant to a collective bargaining agreement relating to the plan which
amends the plan solely to conform to any requirement added by the amendment made
by 1082 subsection (a) shall not be treated as a termination of such collective
bargaining agreement.
(2) INDIVIDUAL PLANS.—The amendment made by subsection (b) shall apply with
respect to health insurance coverage offered, sold, issued, renewed, in effect,
or operated in the individual market on or after the date of enactment of this
Act.
