This brochure is for educational purposes only and it is not intended to serve as legal interpretation of benefits. Reasonable effort is made to have this brochure represent the intent of the contract language. However, the contract language stands alone and is not considered as supplemented or amended in any way by the explanations or examples included in this brochure.
Indiana State University reserves the right to revise benefits periodically.
The federal mandate called the “Women’s Health and Cancer Rights Act of 1998" requires all health plans that cover mastectomies to cover reconstructive surgery as well.
More specifically, if a plan provides medical and surgical benefits with respect to mastectomies, the plan must also provide reconstructive benefits. These benefits include:
*reconstruction of the breast on which the mastectomy was performed
*surgery and reconstruction of the other breast to produce a symmetrical appearance; and
*prostheses and physical complications for all stages of mastectomy.
Although the act requiring coverage of this benefit was signed into effect on October 21, 1998, the Indiana State University Employee Health Benefit Plan has been providing this benefit for many years. As a non-ERISA plan, the Indiana State University Employee Health Benefit Plan is not required by law to abide by the “Women’s Health and Cancer Rights Act of 1998". However, because the University wishes to continue offering quality benefits to the employees and retirees of Indiana State University, the plan will continue to provide this benefit.
DISCLOSURE NOTICE TO PARTICIPANTS
In general, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires certain group health plans to:
1. limit the period for which a group health plan can
deny coverage for a preexisting medical condition to 12 months (18
months for a late enrollee);
2. establish special enrollment rights for certain
employees or dependents:
-if they initially declined to enroll in
the plan because they had other health plan coverage and now have lost
the other coverage, or
-if a person becomes a dependent through
marriage, birth, adoption, or placement for adoption;
3. eliminate any plan rules that base eligibility for
enrollment on an individual’s health status, including evidence of
insurability;
4. provide coverage for at least 48 hours of
hospitalization for mothers and newborns after conventional deliveries
and at least 96 hours of hospitalization after Cesarean sections;
5. provide the same annual and lifetime dollar limits
to mental health benefits under the plan as provided for medical
benefits.
Federal law gives plan sponsors of self-insured non-Federal governmental plans the right to exempt the plan in whole or in part from these requirements. Your plan has elected to provide all items.