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The Women’s Health and Cancer Rights Act of 1998 (WHCRA) was signed into law on October 21, 1998. The WHCRA provides protections for individuals who elect breast reconstruction after a mastectomy. The WHCRA covers women who undergo a mastectomy for any medical reason, not just to treat breast cancer.

Under WHCRA, if your group health plan covers mastectomies, the plan must provide coverage for certain services relating to the mastectomy. However, if your coverage is provided by a “church plan” or “governmental plan”, you will need to check with your plan administrator as certain plans may not be subject to this law.

WHRCA rights apply to individual coverage as well and are generally within the jurisdiction of the state insurance department where you live.

If WHCRA applies to you and you are receiving benefits in connection with a mastectomy and you elect breast reconstruction, coverage must be provided for:

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

The WHCRA requires group health plans and health insurance companies (including HMOs), to notify individuals regarding the coverage required under the law. Notice about the availability of these mastectomy-related benefits must be given:

  1. To participants and beneficiaries of a group health plan at the time of enrollment, and to policyholders at the time an individual health insurance policy is issued; and
  2. Annually to group health plan participants and beneficiaries, and to policyholders of individual policies.

The United States Department of Labor and Health and Human Services oversees this law. For additional information, click HERE, or you can call their toll-free number, 866-487-2365.

While the WHCRA does not apply to Medicare and Medicaid, Medicare does cover breast reconstruction if you had a mastectomy because of breast cancer. Medicaid coverage varies in each state.

For immediate questions about insurance coverage for breast implant removal, please call Kantor & Kantor today for a free consultation or complete our online contact form.