Merritt Personal Lines Manual: Women's Health And Cancer Rights Act

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 insureds covered under group policies and individual health insurance coverage. What the WHCRA doesn't require is for health plans to pay for mastectomies. However, if a health plan chooses to cover mastectomies, then the plan or issuer is generally subject to WHCRA requirements.

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.
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