7.4 Women's Health and Cancer Rights Act

The Women's Health and Cancer Rights Act (WHCRA) is a federal law that requires group health plans (HMOs and other insurers) providing coverage for mastectomies to also cover reconstructive surgery after a mastectomy in a manner determined in consultation with the attending physician and the patient. Prior to this law, the medical plans generally already covered the services now mandated by this law.

Under WHCRA, group health plans and health insurance issuers that provide medical and surgical benefits with respect to a mastectomy must, in the case of a covered individual who is receiving benefits in connection with a mastectomy, also provide coverage for mastectomy-related services including:

• All stages of reconstruction of the breast on which the mastectomy has been 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 lymph edemas.

This coverage will be provided in consultation with the attending physician and the patient, and will be subject to the same 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 contact MedExpert by calling (800) 999-1999.