The WHRCA provides rights related to mastectomy

The Women’s Health and Cancer Rights Act (WHCRA) is a federal law that provides certain rights and protections to patients after a mastectomy. This law requires most health insurance plans that cover mastectomies to also cover breast reconstruction, prostheses and physical complications of all stages of mastectomy, including lymphedema.

The WHCRA applies to:

• Group health plans for plan years starting on or after October 1, 1998
• Group health plans, health insurance companies and HMOs, as long as the plan covers medical and surgical costs for mastectomy

Despite the title, WHCRA benefits are not limited to cancer patients. People who have risk-reducing, prophylactic mastectomies are also entitled to WHCRA benefits as long as the health insurer covers the mastectomy. Also, nothing in the law limits WHCRA benefits to women. Men are covered by the law too.

WHCRA does not require group health plans or health insurance companies to cover mastectomies, however, if the plan does cover this surgery, then it is generally required to abide by the WHCRA. Many states have laws that provide additional protections. Ask your surgeon or check with your state insurance department to learn if you have a right to additional mastectomy-related benefits.

Note that the WHRCA does not require 100% coverage by health insurance so copays, coinsurance and deductibles often apply. 

Exceptions

Some self-funded, short-term, government health plans and plans sponsored by religious organizations are exempt from the WHCRA. Medicare and Medicaid are also exempt from the law's requirements. They have their own rules. Visit our section on Insurance & Paying for Care to learn more.