Benefits for health care: Coverage for mastectomy and reconstructive surgery.
1. If an employer provides health benefits for his employees which include coverage for the surgical procedure known as a mastectomy, he must also provide commensurate coverage for at least two prosthetic devices and for reconstructive surgery incident to the mastectomy. Except as otherwise provided in subsection 2, this coverage is subject to the same terms and conditions that apply to the coverage for the mastectomy.
2. If reconstructive surgery is begun within 3 years after a mastectomy, the amount of the benefits for that surgery must equal those amounts provided at the time of the mastectomy. If the surgery is begun more than 3 years after the mastectomy, the benefits provided are subject to all the terms, conditions and exclusions relating to those benefits at the time of the reconstructive surgery.
3. For the purposes of this section, “reconstructive surgery” means a surgical procedure performed following a mastectomy on one breast or both breasts to reestablish symmetry between the two breasts. The term includes, but is not limited to, augmentation mammoplasty, reduction mammoplasty and mastopexy.
Last modified: February 25, 2006