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The Women’s Health and Cancer Rights Act of 1998

Required Coverage

For participants or beneficiaries of your health plan receiving benefits in connection with a mastectomy, your plan must offer coverage for the following benefits in a manner determined in consultation with the attending provider and the patient:

  • All stages of reconstruction of the breast on which the mastectomy has been performed;
  • Surgery and reconstruction of the other breast to produce a symmetrical appearance;
  • Prostheses; and
  • Treatment of physical complications of mastectomy, including lymphedema.

These required coverages can be subject to annual deductibles and coinsurance provisions if consistent with those established for other medical/surgical benefits under the plan or coverage.

In order to comply with the WHCRA, your plan must offer all of the benefits above.

Does your plan offer all of the benefits listed above?