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Women's Health and Cancer Rights

The federal law known as the Women’s Health and Cancer Rights Act was signed into law in 1998 (Public Law 105-277). This law mandates certain benefits for women who elect to have breast reconstruction in connection with a mastectomy.

Any group or individual health benefit plan, policy or contract that provides medical and surgical benefits for a mastectomy must include the following benefits:

  1. Reconstruction of the breast on which the mastectomy was performed;
  2. Surgery and reconstruction of the other breast to produce a symmetrical appearance;
  3. Prostheses; and
  4. Treatment of physical complications at all stages of the mastectomy, including lymphedemas.

These benefits must be provided as determined by consultation between the attending physician and the patient. Benefits may be subject to the same deductible and coinsurance provisions that would apply to comparable benefits.

Idaho Department of Insurance Bulletin No. 00-2 reminds health companies that the requirements of this federal law apply to health benefit plans offered in this state to Idaho residents.

Idaho Insurance Code requires any health insurance policy that provides coverage for a mastectomy must also provide mammography coverage for at least:

  1. A baseline mammogram for any woman who is 35 through 39 years of age;
  2. A mammogram every two years for any woman who is 40 through 49 years of age, or more frequently if recommended by the woman’s physician;
  3. A mammogram every year for any woman who is 50 years of age or older; and
  4. A mammogram for any woman desiring a mammogram for medical cause.

The coverage may be limited to the cost of the examination. Mammography coverage is not required for specified accident, specified disease, hospital indemnity, Medicare supplement, long-term care, or other limited benefit health insurance policies.

(§41-2144 for individual plans; §41-2218 for group plans; §41-3926 for managed care plans; §41-4025 for self-funded plans; 41-4125 for joint public agency self-funded plans)