I 

108TH CONGRESS 

1ST SESSION H. R. 295

To amend the Internal Revenue Code of 1986 to require group health plans 

to provide coverage for reconstructive surgery following mastectomy, consistent with the Women’s Health and Cancer Rights Act of 1998. 

IN THE HOUSE OF REPRESENTATIVES 

JANUARY 8, 2003

Mrs. KELLY introduced the following bill; which was referred to the 

Committee on Ways and Means 

A BILL

To amend the Internal Revenue Code of 1986 to require 

group health plans to provide coverage for reconstructive 

surgery following mastectomy, consistent with the Women’s Health and Cancer Rights Act of 1998.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Women’s Health and 

5 Cancer Rights Conforming Amendments of 2003’’. 
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1 SEC. 2. CONFORMING THE INTERNAL REVENUE CODE OF 

2 1986 TO REQUIREMENTS IMPOSED BY THE 

3 WOMEN’S HEALTH AND CANCER RIGHTS ACT 

4 OF 1998. 

5 (a) IN GENERAL.—Subchapter B of chapter 100 of 

6 the Internal Revenue Code of 1986 (relating to other re7 quirements) is amended by inserting after section 9812 

8 the following new section:

9 ‘‘SEC. 9813. REQUIRED COVERAGE FOR RECONSTRUCTIVE 

10 SURGERY FOLLOWING MASTECTOMIES. 

11 ‘‘(a) IN GENERAL.—A group health plan that pro12 vides medical and surgical benefits with respect to a mas13 tectomy shall provide, in a case of a participant or bene14 ficiary who is receiving benefits in connection with a mas15 tectomy and who elects breast reconstruction in connection 

16 with such mastectomy, coverage for—

17 ‘‘(1) all stages of reconstruction of the breast 

18 on which the mastectomy has been performed, 

19 ‘‘(2) surgery and reconstruction of the other 

20 breast to produce a symmetrical appearance, and 

21 ‘‘(3) prostheses and physical complications of 

22 mastectomy, including lymphedemas, 

23 in a manner determined in consultation with the attending 

24 physician and the patient. Such coverage may be subject 

25 to annual deductibles and coinsurance provisions as may 

26 be deemed appropriate and as are consistent with those 
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1 established for other benefits under the plan. Written no2 tice of the availability of such coverage shall be delivered 

3 to the participant upon enrollment and annually there4 after. 

5 ‘‘(b) PROHIBITIONS.—A group health plan may not—

6 ‘‘(1) deny to a patient eligibility, or continued 

7 eligibility, to enroll or to renew coverage under the 

8 terms of the plan, solely for the purpose of avoiding 

9 the requirements of this section, and 

10 ‘‘(2) penalize or otherwise reduce or limit the 

11 reimbursement of an attending provider, or provide 

12 incentives (monetary or otherwise) to an attending 

13 provider, to induce such provider to provide care to 

14 an individual participant or beneficiary in a manner 

15 inconsistent with this section. 

16 ‘‘(c) RULE OF CONSTRUCTION.—Nothing in this sec17 tion shall be construed to prevent a group health plan 

18 from negotiating the level and type of reimbursement with 

19 a provider for care provided in accordance with this sec20 tion.’’

21 (b) CLERICAL AMENDMENT.—The table of sections 

22 for chapter 100 of such Code is amended inserting after 

23 the item relating to section 9812 the following new item:

‘‘Sec. 9813. Required coverage for reconstructive surgery following mastectomies.’’

24 (c) EFFECTIVE DATE.—
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1 (1) IN GENERAL.—The amendments made by 

2 this section shall apply with respect to plan years be3 ginning on or after the date of enactment of this 

4 Act. 

5 (2) SPECIAL RULE FOR COLLECTIVE BAR6 GAINING AGREEMENTS.—In the case of a group 

7 health plan maintained pursuant to 1 or more collec8 tive bargaining agreements between employee rep9 resentatives and 1 or more employers, any plan 

10 amendment made pursuant to a collective bargaining 

11 agreement relating to the plan which amends the 

12 plan solely to conform to any requirement added by 

13 this section shall not be treated as a termination of 

14 such collective bargaining agreement.

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