The WHCRA is a federal law that provides women with certain rights after they have had a mastectomy, which is most commonly the result of breast cancer, but may be the result of other health conditions, as well. If you are a woman who has had or will have a mastectomy, the WHCRA provides you with important rights and benefits.
If your group or individual health insurance plan provides for medical and surgical coverage for your mastectomy, your plan must also provide you with coverage for certain procedures and services related to your mastectomy. These services include reconstructive surgery and related procedures, such as surgery on the other breast so that they appear symmetrical, the costs of protheses, as well as treatment for certain complications that can result from having a mastectomy. The requirements of the WHCRA are applicable to all group health insurance plans.
The WHCRA does not require that any health insurance plans, however, pay for the costs of treatment and surgery related to a mastectomy. Thus, if your health insurance plan does not provide for such coverage, the WHCRA will not provide you with any rights or benefits.
Keep in mind, however, that there are certain limitations on the benefits available under WHCRA if you switch health insurance plans. For instance, a new health insurance plan under which you have coverage can deny you coverage for certain preexisting medical conditions for a specified amount of time before it is required to give you coverage for those conditions. However, if, for example, you have a mastectomy that is covered by a health insurance plan, and your employer then switches health insurance plans, the new health insurance plan must cover your reconstructive surgery if it normally covers mastectomies, and you are receiving coverage under that new plan. Therefore, if you must or want to switch health insurance plans for any reason, you should educate yourself about what services related to your mastectomy and/or related medical conditions will be covered, and when that coverage will begin.
The WHCRA also prohibits health insurance companies from denying you enrollment or renewal of benefits in order to avoid their responsibilities under the law. Likewise, insurance companies cannot provide physicians with incentives so that they avoid recommending services and treatments that would result in benefits under the WHCRA. Furthermore, your health insurance plan must send you an initial notice about your rights under the WHCRA, as well as notices on an annual basis thereafter.
While all states must abide by WHCRA, some states provide additional rights and protections related to mastectomy care and related services that go beyond the rights of the WHCRA. Therefore, you should always check with your state insurance department to see if there any additional rights regarding mastectomies to which you are entitled.
You can find more information about WHCRA by visiting the websites of the U.S. Department of Labor or the U.S. Department of Health and Human Services.