After a diagnosis of breast cancer, a woman may need to have all or part of her breast removed as part of her treatment. When all of the breast is removed, this procedure is called a mastectomy. When part of the breast is removed, it is called a partial mastectomy or lumpectomy. The Women’s Health and Cancer Rights Act (WHCRA) helps protect many women who choose to have breast reconstruction after a mastectomy. This federal law, which took effect October 21, 1998, requires most group insurance plans that cover mastectomies to also cover breast reconstruction.
Health Plan Eligibility
- Applies to group health plans for plan years starting on or after October 1, 1998
- Applies to group health plans, health insurance companies, and HMOs, as long as the plan covers medical and surgical costs for mastectomy
Mastectomy Benefits Must Cover:
- Reconstruction of the breast that was removed by mastectomy
- Surgery and reconstruction of the other breast to make the breasts look symmetrical or balanced after mastectomy
- Any external breast prostheses (breast forms that fit into your bra) that are needed before or during the reconstruction
- Any physical complications at all stages of mastectomy, including lymphedema (fluid build-up in the arm and chest on the side of the surgery)
FAQs About Breast Reconstruction Insurance
Does the WHCRA allow insurers to take people off their plans so that they don’t have to pay breast reconstruction insurance benefits?
No. The WHCRA does not allow insurance plans and insurance companies to kick people out of the plan or keep them from enrolling or renewing their coverage under the plan to avoid WHCRA requirements.
Does my insurance provider have to tell me that I’m covered for breast reconstruction under the WHCRA?
Yes. The law also requires that insurance providers notify you of this coverage when you enroll in their plan, and every year after that.
For more information about the WHCRA and additional FAQs, visit the American Cancer Society website.
To learn more about breast reconstruction surgery, contact Dr. Elisabeth Potter online or call 512-324-8320.