May group health plans impose deductibles or coinsurance requirements on the coverage specified in WHCRA?
Yes, but only if the deductibles and coinsurance are consistent with those established for other medical/surgical benefits under the plan or coverage. Can an insurance company refuse to cover reconstructive surgery benefits because an individual’s mastectomy was performed when the individual was covered under a different insurance company? Even though the new insurance company did not cover the individual’s mastectomy, as long as the new insurance company provides benefits for mastectomies, it is generally required to provide coverage for breast reconstruction as well as other required benefits under WHCRA if the individual is receiving benefits under the plan related to the mastectomy. Any restrictions on benefits imposed by the new insurance company because the mastectomy occurred before it covered the individual must comply with HIPAA’s rules limiting a plan or health insurance issuer’s ability to impose a preexisting condition exclusion. What information should be included in the n
Related Questions
- Under WHCRA, may group health plans, insurance companies and HMOs impose deductibles or coinsurance requirements for reconstructive surgery in connection with a mastectomy?
- Under WHCRA, may group health plans, insurance companies or HMOs impose deductibles or coinsurance requirements on the coverage specified in WHCRA?
- What are an employers COBRA compliance requirements with respect to group health plans?
