MANDATE HASTE MAKES WASTEPosted On: Nov. 1, 1998 12:00 AM CST
IF THERE EVER WAS an example of the hazards of last-minute legislating in the employee benefit arena, a mastectomy coverage mandate approved by Congress last month is it.
As mandates go, this one is relatively innocuous, as most employers are already in compliance with its coverage terms. As we reported, the new law requires all health care plans that cover mastectomies to also cover breast reconstruction after a mastectomy and additional surgery to produce a symmetrical appearance.
The new law was prompted by complaints from women who were denied coverage for reconstructive surgery after mastectomies by health care plans that maintained such surgery was only for cosmetic purposes and thus was not covered.
Why any plan would deny coverage for this procedure is beyond us. The reconstructive surgery is performed because of an underlying medical condition. While we doubt that denials of coverage were widespread, apparently they were sufficient to trigger congressional interest and action.
Our complaint is not with the mandate, which for the vast majority of employers will be irrelevant because they already cover breast reconstruction after a mastectomy.
Instead, we take issue with the way Congress enacted the mandate. It tacked the measure onto a budget bill without any debate or consideration during the last hectic days of the session.
As a result of that hasty process, employers now are subject to several baffling requirements to comply with the law. For example, employers must notify all employees in writing by Jan. 1 of the new mandate to cover reconstructive surgery.
If an employer offers coverage for breast reconstruction surgery after a mastectomy, as most now do, why is such special notification necessary?
That strikes us a waste of employers' time and money. Perhaps such notification would be justified if more employers did not already provide coverage, or if there were widespread complaints by employees that they were unaware they were eligible for reconstruction benefits. We certainly aren't aware of such complaints.
Even more puzzling is the requirement that "written notice of the availability of such coverage shall be delivered to the participant upon enrollment and annually thereafter."
Exactly what does that mean? Does it mean that employers have to include in their annual benefit statements language that explicitly states they will cover reconstructive surgery after mastectomies?
If so, why? What is the logic of singling out reconstruction surgery after a mastectomy for specific mention in a benefits statement? Certainly such coverage is important, but so are dozens, if not hundreds, of other surgical procedures that are covered by health plans.
Employers could list every surgical procedure they cover, but soon benefit statements would be so long that few, if any, employees would read them. That is why benefit statements typically broadly state that surgical procedures are covered and only specify those procedures, if any, that are not.
We would hope that the Labor Department, which is charged with providing guidance on how employers are to comply with the reconstruction coverage mandate, can provide some regulatory relief from an unnecessary communications requirement.