Women ’ s Health and Cancer Rights Act
Federal law requires a group health plan to provide coverage for the following services to an individual receiving plan benefits in connection with a mastectomy :
» Reconstruction of the breast on which the mastectomy has been performed ;
» Surgery and reconstruction of the other breast to produce a symmetrical appearance ; and
» Prostheses and physical complications for all stages of a mastectomy , including lymphedema ( swelling associated with the removal of lymph nodes ).
The group health plan must determine the manner of coverage in consultation with the attending physician and patient . Coverage for breast reconstruction and related services will be subject to deductibles and coinsurance amounts that are consistent with those that apply to other benefits under the plan .
Newborns ’ and Mothers ’ Health Protection Act of 1996
Group health plans and health insurance issuers generally may not , under federal law , restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than :
» 48 hours following a normal vaginal delivery , or
» 96 hours following a cesarean section .
However , federal law generally does not prohibit the mother ’ s or newborn ’ s attending provider , after consulting with the mother , from discharging the mother or her newborn earlier than 48 hours ( or 96 hours as applicable ).
In any case , plans and issuers may not , under federal law , require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours ( or 96 hours ).
Mental Health Parity
HRCentral is complying with recent legislation that removes limits on mental health benefits . For example , there must be equality between medical benefits and mental health benefits as to financial requirements ( such as deductibles , copayments , coinsurance , and out-of-pocket maximums ) and quantitative treatment limitations ( such as number of treatments , visits , or days of coverage )
ERISA
As a participant in the HRCentral ’ s benefits program , you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 ( ERISA ). If you would like more information about ERISA , or if you have any questions , you may contact the Human Resources Department or the nearest area office of the Pension and Welfare Benefits Administration , U . S . Department of Labor , listed in your telephone directory . You may also contact the Division of Technical Assistance and Inquiries , Pension and Welfare Benefits Administration , U . S . Department of Labor , 200 Constitution Avenue , N . W ., Washington , D . C . 20220
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