WHCRA ensures that your coverage includes:
Reconstruction of the breast on which the mastectomy was performed;
Surgery and reconstruction of the other breast to produce a symmetrical appearance;
Prosthesis (breast implants);
Treatment of physical complications at all stages of the mastectomy, including lymphedema (swelling caused by an accumulation of lymph fluid in the arm).
It is important for you to know your plan currently provides coverage for mastectomies. As part of this coverage, your plan covers treatment of physical complications at all stages of the mastectomy, including lymphedema and procedures necessary to effect reconstruction of the breast on which the mastectomy was performed, as well as the cost of prostheses (implants, special bras, etc.). Additionally, coverage is provided for any necessary surgery and reconstruction of the breast on which a mastectomy was not performed in order to produce a symmetrical appearance.
Benefits for medical and surgical treatment relating to such coverage will be paid at the same benefit level as other benefits payable under your plan. Please refer to your Plan Document or contact HealthSmart if you have any questions. You will find HealthSmart’s toll free number on your member ID card.
The Women’s Health and Cancer Rights Act (WHCRA) was signed into law on October 21, 1998. The WHCRA amended the Employee Retirement Income Security Act of 1974 (ERISA) and the Public Health Service Act (PHS Act).