Health Care

Womens Health and Cancer Rights Act FAQs

Have you been diagnosed with breast cancer? Are you going to need a mastectomy? Many women choose to have breast reconstructive surgery after a mastectomy. One law that may be able to provide you insurance protection is called the Women's Health and Cancer Rights Act (WHCRA). The US Department of Labor provides information about the WHCRA on its website. Here are answers to some frequently asked questions about women's health and cancer rights.



Q: Is there a federal act that provides protections for women who need breast reconstruction?

  • A:

    The Women's Health and Cancer Rights Act (WHCRA) provides protections to women for breast reconstruction that's connected with a mastectomy. It was signed into law in 1998.



Q:

How will the WHCRA help me with my breast reconstructive surgery if I need a mastectomy after being diagnosed with breast cancer?



  • A:

    The WHCRA will require your insurer, if it offers mastectomy coverage, to cover your reconstructive surgery.



Q:

What types of surgery does the WHCRA require the insurer to cover?



  • A:

    The WHCRA requires coverage for the reconstruction of the breast that needed the mastectomy and for the other breast to help produce an appearance that's symmetrical. It also covers prostheses and physical complications throughout all of the mastectomy stages.



Q:

How do I know if the WHCRA applies to my insurer?



  • A:

    The WHCRA applies to all group health plans, HMOs and insurance companies that offer mastectomy coverage.



Q:

What federal agencies administer the WHCRA?





Q:

Can my insurer require me to pay a deductible or a percentage of my reconstructive surgery expenses?



  • A:

    Your insurer can require you to pay a deductible or a percentage of the expenses as long as it's consistent with the deductible or percentage you pay for the other benefits under your insurance plan.



Q:

Is my insurer required to give me notice of my benefits under the WHCRA?



  • A:

    The WHCRA requires your insurer to notify you of your benefits under the act, both when you enroll in the insurance plan and annually thereafter.



Q:

How does my insurer have to notify me of my benefits under the WHCRA?



  • A:

    Your insurer must follow the disclosure regulations from the US Department of Labor.



Q:

Does my insurer have to follow state law if it offers more protections in connection with a mastectomy than the WHCRA?



  • A:

    State law applies if your insurance coverage is from an HMO or an insurance company. This is called "insured" coverage. Only the WHCRA applies if your coverage is "self-insured" by your employer.



Q:

Does the WHCRA apply to individuals that don't have cancer but need a mastectomy for other reasons?



  • A:

    Yes, since the WHCRA doesn't limit coverage only to cancer patients.

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