Human Resource Blog

Nebraska WHRCA for Breast Augmentation

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One of our employees has come to us with a complaint about the health care company that we use for health insurance because they will not cover the cost of her breast augmentation, which she claims should be covered because of the Nebraska WHRCA. What should we tell her?

There are a number of issues associated with this question. First, the Women’s Health and Cancer Rights Act is a federal Act that may apply to employees in Nebraska, but not necessarily. In order for the Act to apply to employees, the employee needs to have a health care plan that covers the cost of a mastectomy, and not all health care plans cover such a procedure.

Secondly, the health care plan does not necessarily have to come from the employer. However, if the employer does have a health care plan that covers the cost of a mastectomy, the employee still needs to work out a treatment plan with the health care coverage provider and not with the employer.

According to the WHCRA, the health care coverage provider is required to cover the cost of reconstructive surgery after a breast has been removed because of a mastectomy. However, the Act does not require that a health care coverage provider cover the cost of breast augmentation. Augmentation is generally considered to be cosmetic surgery or plastic surgery, whereas reconstructive surgery after a mastectomy is generally done because the breast has been removed because of an illness.

Employees that have coverage under the WHCRA are notified by their health care coverage providers of their rights when they sign up for a health care plan. They are reminded of their WHCRA rights on an annual basis for as long as they have the plan.

In addition to covering the cost of a mastectomy, when a health care coverage plan covers the cost of a mastectomy, the plan should also cover the following:

·         Reconstructive surgery of the breast(s) that have been removed

·         Additional surgery that may be desired in order to create a symmetrical appearance between the breasts

·         Treatment for complications that arise from the reconstructive surgery

·         Treatment for conditions that arise from the surgery, such as lymphoma

·         Minimal levels of treatment and days in the hospital for each procedure. CB