Human Resource Blog

WHCRA in California

What are the rules of the WHCRA in California?

The Womens Health and Cancer Rights Act is a federal Act that was put into place in 1998 in order to help ensure that when a woman has to have a mastectomy, the woman can have treatments for the mastectomy that are covered by the health care policy. The WHCRA applies to those health care policies that already cover the cost of a mastectomy and does not apply to health care policies that do not cover the cost of a mastectomy.

When an employee has a health care policy that covers the cost of a mastectomy, the WHCRA specifically requires that the health care policy cover additional treatments on the breast that has had the mastectomy. There are occasions when an employee may wish to have these treatments performed for reasons that are unrelated to the mastectomy. However, these treatments are only required to be covered by the health care policy, according to the WHCRA, when they are directly associated with the mastectomy.

If an employee has a health care policy that covers the cost of a mastectomy, the health care provider is required to send the employee a notification of the benefits that the employee should receive in conjunction with the mastectomy coverage. This notification should be resent to the employee on an annual basis for as long as the employee has the health care plan. Covered policies may include a group health care plan that is offered through the employer, a health insurance policy, or even benefits offered by a Health Maintenance Organization.

According to the WHCRA, when an employee has coverage for the cost of a mastectomy, the employee should also have coverage for the following conditions or situations:

• Reconstructive surgery that is required or desired after the mastectomy has been performed
• Optional reconstructive surgery that may be desired in order to create a symmetrical appearance between the breasts
• The cost of a prosthetic, including the cost of the prosthetic itself as well as the cost of the implantation of the prosthetic
• Treatment for conditions that result from the mastectomy or treatments for it, such as lymphoma
• Complications of any and all treatments or surgeries that are related to the mastectomy. CB