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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.
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).
Enrollment Notice
A notice must be provided to all employees at the time of enrollment in the health plan. This notice shall:
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.
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.”
Click here for helpful information regarding the Women’s Health & Cancer Rights Act.
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