Breast Prosthesis / Mastectomy Prosthesis

A breast prosthesis, also called a mastectomy prosthesis, is a covered medical device used to restore body contour after breast surgery. Health plans often reimburse part of the cost of external breast forms, specialized bras, or related supplies when deemed medically necessary by a physician.

Coverage ensures financial support for patients recovering from mastectomy or lumpectomy procedures. Reimbursement limits may apply per breast and per defined time period, such as once every two years.

Example:

If your plan covers up to $300 per breast every two years and you purchase prostheses costing $450 each, the plan reimburses $600 in total and you pay $300.

What to Watch For:

Pre-authorization or a prescription is often required. Some plans classify post-surgical bras separately with their own smaller maximums.

Related Terms

Beneficiary

A beneficiary is the person or entity designated to receive the proceeds or benefits from an insurance policy upon the policyholder’s death or when a covered event occurs. In life insurance, the beneficiary receives the death benefit as a tax-free lump sum. In accidental death and dismemberment (AD&D) insurance, the beneficiary receives payment if the insured person dies as the result of an accident. Beneficiaries can also be designated in certain health or travel plans that include accidental death benefits.

Benefit

A benefit is the specific financial protection or coverage provided under an insurance policy. In health and dental insurance, a benefit refers to the payment or reimbursement made by the insurer for eligible medical, dental, or wellness expenses. Each benefit category - such as prescription drugs, dental services, vision care, or physiotherapy - outlines what is covered, how much the insurer will pay, and any applicable limits or conditions.

Benefit Period (Vision)

The benefit period for vision refers to how often your vision care coverage renews and allows you to make new claims for eligible expenses such as glasses, contact lenses, or eye exams. Unlike other benefits that reset each year, vision care often renews every two benefit periods, which can mean every 24 consecutive months rather than every calendar year.

Benefit Survival Period

A benefit survival period is the minimum amount of time a policyholder must remain alive after being diagnosed with a covered condition before an insurance benefit becomes payable. This period ensures that the illness or injury meets the policy’s criteria for a valid claim and prevents immediate payouts for conditions that result in death shortly after diagnosis.

Blood Glucose Monitor / CGM Devices

Blood glucose monitors and continuous glucose monitoring (CGM) devices are tools used to measure and track blood sugar levels for individuals with diabetes. A standard blood glucose monitor requires a small finger-prick blood sample to provide a reading, while a CGM system uses a small sensor worn on the body to record glucose levels continuously throughout the day and night.

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