Women's Health and Cancer Rights Act (WHCRA)

A federal law requires group health plans including HMOs and other insurance companies providing coverage for mastectomies to also cover reconstructive surgery after a mastectomy. The purpose of this notice is to remind you and your covered spouse of the following benefits available to you if you undergo a mastectomy:

  • Reconstruction of the breast on which the mastectomy was performed;
  • Surgery and reconstruction of the other breast to produce a symmetrical appearance;
  • Prostheses; and
  • Treatment of physical complications in all stages of the mastectomy, including lymphedemas.

Your medical coverage in connection with any treatment involving a mastectomy will be provided in consultation with the attending physician and the patient.

Your coverage for treatment of a mastectomy will be subject to annual deductibles and coinsurance provisions that are consistent with those established for other benefits under the plan or coverage.

If you have any questions, contact your HMO directly or call the Administrative Office for assistance.

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