Search Frequenty Asked Questions

General Questions and Answers on the Women's Health and Cancer Rights Act

Questions:

1. Under WHCRA, may group health plans and health insurance issuers impose deductibles or coinsurance for reconstructive surgery in connection with a mastectomy?
2. Are health plans required to give me notice of WHCRA benefits?
3. Does WHCRA affect the amount that my health plan will pay my doctors?

Answers:

1) Under WHCRA, may group health plans and health insurance issuers impose deductibles or coinsurance for reconstructive surgery in connection with a mastectomy?

Yes, but only if the deductibles and coinsurance are consistent with the cost-sharing arrangements that apply to other benefits under the plan or coverage.

2) Are health plans required to give me notice of WHCRA benefits?

Yes. Both group health plans and health insurance issuers are required to provide you notice of WHCRA benefits upon enrollment and annually thereafter.

3) Does WHCRA affect the amount that my health plan will pay my doctors?

No. WHCRA does not prevent a plan or health insurance issuer from negotiating the level and type of payment with attending providers. However, the law prohibits plans and issuers from penalizing attending providers or providing incentives that would induce a provider to provide care that is inconsistent with WHCRA.