Your Breast Reconstruction Surgery Benefits

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Your Breast Reconstruction Surgery Benefits


The Women’s Health and Cancer Rights Act of 1998 requires health plans to cover breast reconstruction following a mastectomy. All health plans also have to provide plan participants with a notice of this coverage each year.

We understand there are many important decisions to consider before undergoing reconstructive breast surgery. That’s why we want to make sure you’re fully aware of your benefits.

If a covered EmblemHealth member has a mastectomy, lymph node dissection or lumpectomy and decides after consulting with his or her doctor to have reconstructive surgery, covered services include:

  • Reconstruction of the breast on which the mastectomy was performed
  • Prostheses
  • Surgery and reconstruction of the other breast to produce a symmetrical (similar) appearance
  • Treatment of physical complications at any stage of the mastectomy, including lymphedema care

Please be aware that this coverage is only for members diagnosed with breast cancer. The benefits do not apply to elective cosmetic surgery, which is not covered.

If you have any questions about this or any of your other benefits, please call customer service or visit