Bulletin No. 1998-14
To: All Companies Authorized to Transact Accident and Health Insurance Business in the State of Kansas.
From: Kathleen Sebelius, Commissioner of Insurance
Subject: Women’s Health and Cancer Rights Act of 1998.
Date: November 6, 1998
The purpose of this bulletin is to advise all companies authorized to transact accident and health insurance business in the State of Kansas of the passage by Congress of the Women’s Health and Cancer Rights Act of 1998. (Title IX of H.R. 4328)
Required Coverage for Reconstructive Surgery Following Mastectomies.
A group or individual 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:
This benefit shall be determined in consultation with the attending physician and the patient.
Such coverage may be subject to the policy’s annual deductibles and coinsurance provisions. Written notice of the availability of such coverage shall be delivered to the participant upon enrollment and annually thereafter.
A group or individual health insurer shall provide written notice regarding the coverage required by this Act in accordance with federal regulations. Such notice shall be in writing and prominently positioned in any literature or correspondence made available or distributed by the insurer and shall be transmitted:
A group or individual insurer offering medical and surgical benefits, may NOT:
Nothing in this Act shall be construed to prevent an insurer offering insurance coverage from negotiating the level and type of reimbursement with a provider for care provided in accordance with this Act.
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.
The benefit requirements of this Act shall apply with respect to health insurance coverage offered, sold, issued, renewed or operated in the individual market on or after October 21, 1998. With respect to group plans, the benefit requirement of this Act shall apply to plan years beginning on or after October 21, 1998.
The purpose of this bulletin is to make each affected company aware of the passage of the Women’s Health and Cancer Rights Act of 1998. Companies are hereby advised to notify all company representatives in marketing and claims personnel of this new law. If applicable, please furnish this department with any amendatory rider or contract forms necessary to insure compliance with this Act.
If you have any questions or comments regarding this Bulletin, please contact the Accident and Health Division of the Kansas Insurance Department, 420 SW 9th Street, Topeka, Kansas 66612, (785) 296-7850.