Retiree Health WHCRA FAQs

  1. I've been diagnosed with breast cancer and plan to have a mastectomy. How will WHCRA affect my benefits?

    Under WHCRA, group health plans, insurance companies, and health maintenance organizations (HMOs) offering mastectomy coverage must also provide coverage for reconstructive surgery in a manner determined in consultation with the attending physician and the patient. Coverage includes reconstruction of the breast on which the mastectomy was performed, surgery, and reconstruction of the other breast to produce a symmetrical appearance, and prostheses and treatment of physical complications at all stages of the mastectomy, including lymphedemas.

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  2. Will WHCRA require all group health plans, insurance companies, and HMOs to provide reconstructive surgery benefits?

    All group health plans, and their insurance companies or HMOs that provide coverage for medical and surgical benefits with respect to a mastectomy are subject to the requirements of WHCRA.

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  3. Under WHCRA, may group health plans, insurance companies, or HMOs impose deductibles or coinsurance requirements for reconstructive surgery in connection with a mastectomy?

    Yes, but only if the deductibles and coinsurance are consistent with those established for other benefits under the plan or coverage.

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