Changes To Your Health Plan

Women's Health & Cancer Rights Act

A recently enacted federal law, called the Women's Health and Cancer Rights Act of 1998, requires group health plans and insurers providing coverage for mastectomies to also cover reconstructive surgery after a mastectomy. This coverage under the Women's Health and Cancer Rights Act is effective for the Northern California Construction Workers Health Trust January 1, 1999.

This coverage applies to both of the HMO plans for active employees, Kaiser & CaliforniaCare; and for the retiree Medicare Risk plans as well including Senior Advantage, Senior Secure and Secure Horizons. The Indemnity Plan for active employees will also provide coverage for reconstructive surgery.

The plans generally already cover the services now mandated by the new law. The purpose of this notice is merely to remind you and your covered family members of the following:

Under Federal law, group health plans and health insurance issuers that provide medical and surgical benefits with respect to a mastectomy must, in the case of a covered individual who is receiving benefits in connection with a mastectomy, provide coverage for: reconstruction of the breast on which the mastectomy has been performed; surgery and reconstruction of the other breast to produce a symmetrical appearance; prostheses and physical complications in all stages of the mastectomy, including lymphedemas; in a manner determined in consultation with the attending physician and the patient.

Such coverage may be subject to annual deductibles and coinsurance provisions which are consistent with those established for other benefits under the plan of coverage.

Also a reminder that early detection is crucial to the fight against breast cancer. It increases your survival and treatment options. One way you can take charge of your health is to do a breast self-exam every month. The best time to do the exam is the week following your period. If you are no longer menstruating, pick the same day every month. This will help you establish a routine.

The Newborns' and Mothers' Health Protection Act

Starting in 1998 health plans are required to provide coverage for a minimum of a 48-hour stay for the mother and newborn following a vaginal delivery, and at least a 96-hour maternity stay following a cesarean section. Under this new law, a mother and newborn can leave prior to the minimum stay, provided there is a mutal agreement between the mother and doctor. All of the medical plans under the Northern California Construction Workers Health Plan provide this maternity benefit.

If you have any questions, please call the Administrative Office at (123) 456-7890