You probably know that October is Breast Cancer Awareness Month. Every October there are nationwide campaigns to raise awareness of the importance of early detection and treatment and to raise funds to find a cure.
While we know there is still a lot to do when it comes to beating breast cancer, what a lot of people don’t know is that there are protections related to the detection and treatment of breast cancer that are already available.
Whether you or a loved one has breast cancer, or if you’d simply like to know more about prevention, here is some important information:
1. Preventive services such as mammograms may be available under your plan free of charge.
Under the Affordable Care Act, your plan may cover recommended preventive services, such as breast cancer mammography screenings for women 40 years of age and older, with no copayment, coinsurance or deductible.
2. If you had or plan to get a mastectomy, you may have rights related to reconstructive surgery, prostheses and more.
Under the Women’s Health and Cancer Rights Act, group health plans and health insurance companies offering mastectomy coverage must provide coverage for certain services relating to the mastectomy in consultation with you and your attending physician. WHCRA covers all stages of reconstruction of the breast on which the mastectomy was performed, surgery and reconstruction of the other breast to produce a symmetrical appearance, prostheses, and treatment of physical complications of the mastectomy, including lymphedema.
3. You no longer can be denied health coverage because you had breast cancer.
Under the Affordable Care Act, you generally cannot have coverage limited or denied because of a preexisting condition like breast cancer.
4. Check your plan documents to learn about your rights under your plan.
Your health plan administrator should provide a copy of your Summary Plan Description. It outlines your benefits and your legal rights. You also can find many of the answers to your questions in the Summary of Benefits and Coverage, a short, easy-to-understand summary of what a plan covers and what it costs. If you were required to pay cost-sharing for a preventive service, such as a mammogram, check your Explanation of Benefits and ensure that the provider billed the service properly.
5. We can help answer your questions.
The Employee Benefits Security Administration can answer your questions about WHCRA, the Affordable Care Act, and more. Our Benefits Advisors also can assist you if you believe you have been denied a health benefit inappropriately. Contact us online at askebsa.dol.gov or by calling toll-free 1-866-444-3272.
Take the time this month to get to know your health benefit rights so that you can take advantage of the protections and your health coverage.
Phyllis C. Borzi is the Assistant Secretary for Employee Benefits Security.
