The bill would require many group health plans and individual or group health insurers that cover breast cancer treatment to cover related breast or chest wall reconstruction. Coverage would include different reconstruction methods and stages, surgery to create symmetry, custom breast prostheses, and treatment for related physical complications, including lymphedema. Plans would need at least one in-network provider for each covered method and approach, and would have to give members written notice each year. The bill would also require a report to Congress on barriers to access. It has been referred to House committees and has not been enacted.
If enacted, the coverage rules would apply to plan years starting on or after enactment. For people receiving breast cancer treatment who choose reconstruction and are medically eligible, the plan would determine coverage in consultation with the patient and attending physician. State laws requiring at least the same coverage would remain in place.
Plans could apply deductibles and coinsurance consistent with those for other benefits. No publicly available information on the bill’s overall cost or its effect on premiums.
No publicly available information.
No publicly available information.