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WCHRA in Pennsylvania

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One of our managers has just learned that she has breast cancer. How does the WHCRA help to protect her in Pennsylvania?

The Womens Health and Cancer Rights Act (WHCRA) is a federal Act that is in place to protect the rights of employees in all states, including Pennsylvania. The Act applies to all employees that are covered.

WHCRA basically states that if a health care coverage plan, such as health insurance or an HMO, covers the cost of a mastectomy, that plan needs to also cover the cost of reconstructive surgery after the mastectomy. Not all health care plans cover the cost of the mastectomy. In such a situation, then the WHCRA does not require that the healthcare plan cover reconstructive surgery.

In order to determine whether or not employees have coverage for the cost of the reconstructive surgeries, employers and employees simply need to review the health care policy that the company uses. If your health care policy does not cover the cost of a mastectomy, then it will not be required by the WHCRA to cover the cost of the reconstructive surgery.

In addition to the mastectomy and the reconstructive surgery that might follow the mastectomy, the WHCRA requires that the health care coverage provider also cover the following:

• The cost of a prosthetic, if one is needed.
• Any reconstructive surgery that is intended to create a symmetrical appearance between the breasts.
• All complications associated with either surgery, including lymphoma.
• Minimum hospital stays and treatments.
• Any additional surgeries that result from complications or other needs – both during the mastectomy and the reconstructive surgery processes.

The WHCRA requires that the patient pay for any normal deductibles for treatment as well as any annual fees that might be associated with treatment. Also, the WHCRA prohibits employers and other interested parties from bribing doctors or health care professionals to reduce the amount of treatment or the length of the hospital stay for a patient so as to save money. CB