Women’s Health and Cancer Rights Act

The Women’s Health and Cancer Rights Act (WHCRA) includes protections for individuals who elect breast reconstruction in connection with a mastectomy. WHCRA provides that group health plans and health insurance issuers that provide coverage for medical and surgical benefits with respect to mastectomies must also cover certain post-mastectomy benefits.

Plans Covered

Generally, group health plans, insurance companies and HMOs, that provide coverage for medical and surgical benefits with respect to a mastectomy must comply with WHCRA.

However, certain plans, including church plans or governmental plans may not be subject to this law.  For more information, see Additional Resources for a link to the Department of Labor web site (See Additional Resources for a link to the Department of Labor web site for more information).

Notices

Enrollment Notice

A notice must be provided to all employees at the time of enrollment in the health plan.  This notice shall:

• Specify coverage will be provided in a manner determined in consultation with the attending physician and the participant who will be receiving the mastectomy-related benefits.
• Describe any deductibles and coinsurance limitations that apply to the coverage specified under WHCRA.

Deductibles and coinsurance limitations may be imposed only if they are consistent with those established for other benefits under the plan or coverage.

Annual Notice

An annual notice should be sent to all plan participants and should describe the coverage required under WHCRA and information on how to obtain a detailed description of the mastectomy-related benefits available under the plan.

• The annual notice may be the same notice provided when the participant enrolled in the plan if it contains the information described above.
• The annual notice can be delivered at any time during the plan year; therefore, you may combine this notice with other notices, or other open enrollment materials.
• Rather than a standalone notice, it can be included in the SPD if the plan distributes SPDs annually to all plan participants.
• A separate notice must be furnished to a group health plan beneficiary where the last known address of the beneficiary is different than the last known address of the covered participant
• It is legally permissible to include the Newborns’ and Mothers’ Health Protection Act on the same notice.

Sample Notice:
“Do you know that your plan, as required by the Women’s Health and Cancer Rights Act of 1998, provides benefits for mastectomy-related services including all stages of reconstruction and surgery to achieve symmetry between the breasts, prostheses, and complications resulting from a mastectomy, including lymphedema? Call your plan administrator [insert plan administrator phone number here] for more information.”

Additional Resources

Department of Labor Web Site

Click here for helpful information regarding the Women’s Health & Cancer Rights Act.