Summary
The Federal Women’s Health and Cancer Rights Act (WHCRA) was passed in 1998 and requires coverage of treatment related to mastectomy. If you are eligible for mastectomy benefits under your health coverage and you elect breast reconstruction in connection with such mastectomy, you are also covered for the following:
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Reconstruction of the breast on which mastectomy has been performed;
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Surgery and reconstruction on the other breast to produce a symmetrical appearance;
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Prostheses;
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Treatment of physical complications of all states of mastectomy, including lymphedemas.
Coverage for reconstructive breast surgery may not be denied or reduced on the grounds that it is cosmetic in nature or that it otherwise does not meet the coverage definition of “medically necessary.” Benefits will be provided on the same basis as for any other illness or injury under your plan. Coverage is subject to applicable deductibles, copayments and coinsurance payments.