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The Women's Health and Cancer Rights Act


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Summary
Questions and Answers
Notice Requirements
Statutory Text

Summary Information

Overview

The Women's Health and Cancer Rights Act of 1998 (WHCRA) is a federal law that provides protections to patients who choose to have breast reconstruction in connection with a mastectomy. This law applies generally both to persons covered under group health plans and persons with individual health insurance coverage. But WHCRA does NOT require health plans or issuers to pay for mastectomies. If a group health plan or health insurance issuer chooses to cover mastectomies, then the plan or issuer is generally subject to WHCRA requirements.

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

  • Reconstruction of the breast on which the mastectomy has been performed;,
  • Surgery and reconstruction of the other breast to produce a symmetrical appearance;
  • Prostheses (e.g., breast implant); and
  • Treatment for physical complications of the mastectomy, including lymphedema.
Coverage under WHCRA

Whether WHCRA or a State law that affords you the same coverage as WHCRA applies to your coverage will depend on your situation. Generally, WHCRA applies if you are in a self-insured plan. Your State law will determine whether WHCRA will apply to coverage under an insured group plan, or to individual health insurance coverage.

Contact your State's insurance department to find out about whether WHCRA will apply to your coverage if you are NOT in a self-insured health plan.

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Answers to Commonly Asked Questions

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Notice Requirements

The WHCRA requires group health plans and health insurance issuers, including insurance companies and HMOs, to notify individuals regarding coverage required under the law. Notification is required at three separate times:

  1. After enactment of WHCRA
  2. Upon enrollment
  3. Annually.

View the Questions & Answers on the Annual Notice Requirements. The Q & A document contains a Model Annual Notice, which will be particularly useful to plans and issuers.

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Statutory Text

The Women's Health and Cancer Rights Act (P.L. 105-277), enacted October 21, 1998, which amended the Public Health Service Act (PHS Act) and the Employee Retirement Income Security Act of 1974 (ERISA). The law is administered by the Department of Health and Human Services (DHHS) and the Department of Labor. The WHCRA includes important new protections for individuals who have had a mastectomy and who elect breast reconstruction in connection with the mastectomy.

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Last Modified on Friday, September 17, 2004