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Health Care and Masectomy

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We have recently had an employee be diagnosed with breast cancer. I understand that there is something that our company’s health care policy covers when it comes to her mastectomy. Please explain.

There are a variety of health care treatments that are covered for all of your employees. There are also those healthcare treatments that are written into policies specifically to protect women in your company. One of those treatments is protected by a federal Act that helps to establish the terms that a healthcare policy will have to abide by. The Women’s Health and Cancer Rights Act (WHCRA) was established in 1998 as a federal plan that requires a company’s health plan to cover the cost of mastectomies. The plan also requires that a company’s health care plan pay for the reconstructive surgery that the patient might need in connection with the mastectomy.

The WHCRA is in place to protect women when they are part of a group health plan, enrolled in a health insurance company or involved in care with an HMO. As long as the plan provides for medical and surgical benefits for a mastectomy, the plan must also offer coverage for reconstructive surgery. However, the WHCRA does not require that a company  insurance plan, group health plan, or HMP provide reconstructive surgery for all reconstructive surgery needs. For example, just because the plan allows for reconstructive surgery following a mastectomy, the plan does not have to offer reconstructive benefits after a fire-related injury or any other reconstructive surgery need.

The WHCRA covers:

Reconstructive breast surgery after a mastectomy

Reconstructive surgery for the creation of symmetrical breasts

Prostheses during the stages of the mastectomy, including lymphedema

Of course, even with the WHCRA, all of the benefits may come with annual deductibles and co-insurance coverage that are the same as other surgeries under the health insurance plans. Your employee will still have to pay for those visits and the deductibles per each visit, as would any other employee in your company that was having medical treatment for any reason. As such, the act is in place to protect the rights of women to have reconstructive surgery when they otherwise might not if their health coverage was too expensive to have the surgery.