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legal disclosures
Continuation of Medical, Dental & Vision Newborns’ and Mothers’ Health Protection Act
Coverage (COBRA)
Under the Newborns’ and Mothers’ Health Protection Act of
Federal and state law requires most employers to offer 1996, group health plans and health insurance issuers offering
employees and their lawful spouses and dependent children group health insurance coverage generally may not, under
the opportunity to temporarily continue their existing health federal law, restrict benefits for any hospital length of stay in
care coverage at group rates plus a 2% administrative fee, in connection with childbirth for the mother or newborn child to
certain situations where coverage would otherwise end. The less than 48 hours following vaginal delivery or less than 96
employee must pay for this coverage. Note: Requirements hours following a cesarean section, or require that a provider
may differ by state. obtain authorization from the plan or insurance issuer for
prescribing a length of stay not in excess of the above periods.
For details of your rights to coverage continuation, please refer
to the COBRA Initial Notice available from Human Resources. The law generally does not prohibit an attending provider of
the mother or newborn, in consultation with the mother, from
Women’s Health & Cancer Rights Act of 1998 discharging the mother or newborn earlier than 48 or 96
hours, as applicable.
When a person insured for benefits under the Highmark BCBS
medical plans has a mastectomy and at any time decides to Mental Health Parity
have breast reconstruction, based on consultation between
attending physician and the patient, the following benefits will The Mental Health Parity and Addiction Equity Act of 2008
be subject to the same coinsurance and deductibles, which requires plans to provide mental health and substance abuse
apply to other plan benefits: benefits at the same level that benefits for medical and
surgical related benefits are offered. Key provisions that affect
Reconstruction of the breast on which the mastectomy most group health plans include:
was performed;
Group health plans are prohibited from having annual or
Surgery and reconstruction of the other breast to produce lifetime maximum dollar limits for mental health benefits that
symmetrical appearance; are lower than medical or surgical benefits.
Treatment of physical complications in all stages of The law expands mental health benefits to include substance
mastectomy, including lymphedema; and use disorder benefits.
Mastectomy bras and external prostheses limited to the Cost-sharing provisions, such as deductibles and copays, or
lowest cost alternative available that meets the patient’s a plan’s terms regarding the amount, duration and scope of
physical needs. mental health benefits are no longer restricted from the plan.
If you have questions about your benefits under the Highmark
BCBS medical plans, please call the member services number
on your medical ID card or contact Human Resources.
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