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UFCW LOCAL 1776 and
PARTICIPATING EMPLOYERS HEALTH and WELFARE FUND |
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Other Federal Law Requirements |
| Mastectomies And Reconstructive Surgery |
Under federal law, group health plans that provide
medical and surgical benefits in connection with a mastectomy must provide
benefits for certain reconstructive surgery effective January 1, 1999.
In accordance with federal law, the Plan pays
for mastectomy-related services including 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 treatment of physical
complications at all stages of mastectomy, including lymphedemas.
This coverage will be provided in a manner
determined in consultation with the attending physician and the patient,
subject to the general provisions of the applicable medical coverage relating
to benefits, pre-certification and other applicable limitations, including
annual deductibles, co-payments and coinsurance provisions.
If you have any questions about mastectomies
and reconstructive surgery under your medical coverage, please contact the Fund
office. Benefits For Mothers And Newborns Under your medical coverage, and as required by law, the Plan generally may not 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 vaginal delivery, or less than 96 hours following a cesarean section. However, these requirements generally do 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, the Plan may not require that a provider obtain authorization from the Plan for prescribing a length of stay not in excess of 48 hours (or 96 hours). |