Reconstructive Breast Surgery after a Mastectomy
The following is a required annual notification under the Women's Health and Cancer Rights Act of 1998. This federal law requires health plans that provide mastectomy benefits to inform their plan members of its availability. This is not a change to your current benefit; PHP has always provided this benefit to our members.
Benefits for women following a mastectomy should be determined in consultation between the attending personal physician/provider and the patient. PHP members are entitled to the following coverage:
- Reconstruction of the breast on which the mastectomy was performed
- Surgery and reconstruction of the other breast to produce a symmetrical (balanced) appearance
- Prostheses (artificial replacements) and treatment of physical complications of all stages of mastectomy, including lymphedemas
These reconstructive benefits may be subject to annual deductibles and co-insurance provisions, like other medical and surgical benefits covered under the plan.
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