Bill > HR5813

This bill, called the "Women's Health and Cancer Rights Modernization Act of 2025", requires group health plans and health insurance issuers to provide comprehensive coverage for breast or chest wall reconstruction for patients undergoing breast cancer treatment. The bill mandates coverage for a wide range of medical services, including all modalities and types of breast reconstruction (such as implant-based, tissue-based, and future techniques), surgical procedures to create symmetrical appearance, custom breast prostheses, and treatment of physical complications from mastectomy or related surgeries. Health plans must ensure at least one in-network provider is available for each reconstruction type, and they cannot deny coverage or penalize healthcare providers for providing medically appropriate reconstruction services. The bill also requires health plans to provide written notice about these reconstruction coverage options to patients upon enrollment and annually, and it does not prevent health plans from negotiating reimbursement levels with providers. The legislation applies to plan years beginning on or after the date of enactment and aims to modernize and expand breast cancer reconstruction coverage across different types of health plans, including those governed by the Public Health Service Act, Employee Retirement Income Security Act, and the Internal Revenue Code.

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https://www.congress.gov/bill/119th-congress/house-bill/5813/all-info