On April 20, 2023, the New Mexico Office of Superintendent of Insurance (OSI) issued Bulletin 2023-008 to remind major medical plans subject to its jurisdiction of their obligations under the federal Women’s Health and Cancer Rights Act of 1998 (WHCRA).
Generally, WHCRA requires major medical plans that provide medical and surgical benefits for mastectomies to also provide coverage for all stages of reconstruction of the breast on which the mastectomy has been performed, surgery and reconstruction of the other breast to produce a symmetrical appearance, prostheses, and treatment of physical complications of all stages of the mastectomy, including lymphedema.
The bulletin also specifies that a plan’s failure to comply with the WHCRA may result in adverse action by the OSI, including monetary penalties, suspension, revocation, or denial of a license or certificate of authority, as well as the denial of approval of any related insurance filings that are presently under review.
WHCRA is a federal law, but state insurance regulators generally monitor plan compliance with federal laws along with state laws as a matter of course. Both health insurers and group health plan sponsors will want to be aware of the OSI’s stated intention to closely monitor compliance with WHCRA requirements.