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Yes. The law also requires that insurance providers notify you of this coverage when you enroll in their plan and every year after that.

Several states have laws requiring health plans that cover mastectomies to provide coverage for reconstructive surgery after a mastectomy. These state laws only apply to health plans purchased by an employer from a commercial insurance company. If an employer is self-insured, state laws do not apply. However, the federal laws do.

A self-insured (or self-funded) plan is one in which the employer, rather than a commercial insurance company, pays for the insured person’s health expenses. Some employers that self-insure hire a commercial insurance company to process claims so it can be hard to tell whether you have a self-insured plan or a commercially insured plan.

If you do not know what type of plan you have, ask your employer’s benefits manager or contact your state insurance department.

Under the WHCRA, group health plans, insurance companies, and health maintenance organizations (HMOs) that offer mastectomy coverage must also provide coverage for reconstructive surgery after mastectomy.

This federal law ensures that most women can have breast reconstruction after mastectomy if they choose. They often have this benefit even if they live in states that do not make insurance companies provide this coverage.

Yes, they can. But the deductibles and co-insurance must be consistent with those for other benefits under the plan. The insurance company cannot make you pay a higher deductible or co-pay for breast reconstruction than you would pay for other types of surgery.

It depends. The WHCRA does not require minimum hospital stays. However, your state may have minimum stay laws.

Check with your State Insurance Commissioner’s office to see if your state has these laws.

No. The WHCRA does not keep an insurance plan or health insurance issuer from bargaining about amounts and types of payment with doctors. But the law forbids insurance plans and issuers from punishing doctors or giving incentives for providers to give care that’s not consistent with WHCRA.

No. The WHCRA was not changed by the Affordable Care Act and there are no requirements or regulations that affect it. Health insurance plans that offer mastectomy must continue to offer breast reconstruction.

The ACA also protects people with pre-existing conditions. For plan years beginning on or after January 1, 2014, group health plans generally cannot limit or deny benefits based on a pre-existing condition.

For more information about the ACA, see Can I Get Health Insurance If I Have Cancer?

While this law does not apply to Medicare and Medicaid, Medicare covers breast reconstruction if you had a mastectomy because of breast cancer.

Medicaid coverage varies in each state, so contact your state Medicaid office for details.

For more information, you can contact the following organizations.

• For , contact the US Department of Labor. You can call their toll-free number at 1-866-487-2365.
• For information about employer-based health insurance, contact the Employee Benefits Security Administration of the Department of Labor. Call them at 1-866-444-3272.  
• To find out what benefits your insurance plan covers, contact your health plan administrator. Their number should be listed on your insurance card.
• To learn about , contact your State Insurance Commissioner’s office or call 1-866-470-6242.