FAQs About Women's Health And Cancer Rights What is the Women's Health and Cancer Rights Act (WHCRA)?
I have been diagnosed with breast cancer and plan to
have a mastectomy. How will WHCRA affect my benefits?
Will WHCRA require all group health plans, insurance
companies and HMOs to provide reconstructive surgery benefits?
Under WHCRA, may group health plans, insurance
companies and HMOs impose deductibles or coinsurance requirements for
reconstructive surgery in connection with a mastectomy?
When do these requirements take effect?
My state requires the coverage for breast
reconstruction that is required by WHCRA and also requires minimum
hospital stays in connection with a mastectomy that are not required by
WHCRA. If I have a mastectomy and breast reconstruction, am I also
entitled to the minimum hospital stay?
If state law meets these requirements, then it applies to coverage provided by an insurance company or HMO ("insured" coverage). If you obtained your coverage through your employer and your coverage is "insured," you would be entitled to the minimum hospital stay required by state law. If you obtained your coverage through your employer but your coverage is not provided by an insurance company of HMO (that is, your employer "self-insures" your coverage), then state law does not apply. In that case, only the federal WHCRA applies and it does not require minimum hospital stays. To find out if your group health coverage is "insured" or "self-insured," check your Summary Plan Description (SPD) or contact your plan administrator. If you obtained your coverage under a private individual health insurance policy (not through your employer), check with your State Insurance Commissioner's Office to learn if state law applies. What are the notice requirements under WHCRA?
Are all group health plans, and their insurance
companies and HMOs, required to satisfy the notice requirements under
WHCRA?
How must these notices be delivered to participants and
beneficiaries?
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