Women’s Health and Cancer Rights Act of 1988


Under federal legislation, annual notification of this benefit is required to all members.

2018 Notification

In 1998, the federal government enacted a law that mandates certain health coverage for breast reconstructive surgery in any health program that provides medical and surgical benefits for mastectomies. This law is known as the Women’s Health and Cancer Rights Act.

If a covered person is receiving benefits in connection with a mastectomy and elects to have breast reconstruction along with that mastectomy, the policy must provide in a manner determined in consultation with the attending physician and the patient, coverage for the following:

  • 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; and
  • Prostheses and physical complications at all stages of the mastectomy, including lymphedemas.

These benefits will be provided subject to deductibles and coinsurance to the same extent as for any other illness under your coverage. All other features and benefits of this program remain the same and are not impacted by this annual notification.

Getting information about your health benefits

Horizon Blue Cross Blue Shield of New Jersey is committed to helping you understand your health benefits. Visit HorizonBlue.com/focus to learn more about:

Getting care, including:

  • How to get primary care, specialty care and hospital and behavioral health services
  • How to get care after hours
  • How and when to get emergency care or call 911 or your local emergency response system
  • How and when to change from a pediatric doctor to an adult-care doctor

Your benefits and coverage, including:

  • How to find which services are included in your plan
  • How to find information about getting care outside of your plan’s coverage area
  • Where to find your copayment, deductible and coinsurance information
  • How to submit a claim for covered services
  • How to submit a complaint or an appeal

Horizon BCBSNJ programs, including:

  • Our pharmaceutical management procedures
  • How Horizon BCBSNJ evaluates new medical technology for inclusion as a covered benefit
  • Our Chronic Care and Case Management programs, and how to enroll
  • How to contact our Utilization Management Department, including after-hours contact information

Your member rights, including:

  • Your rights and responsibilities as a Horizon BCBSNJ member
  • How to get help in another language