Women’s Health and Cancer Rights Modernization Act of 2025

The Women's Health and Cancer Rights Modernization Act of 2025 aims to significantly expand health insurance coverage for breast and chest wall reconstruction. It achieves this by amending the Public Health Service Act, the Employee Retirement Income Security Act of 1974 (ERISA), and the Internal Revenue Code of 1986. The bill mandates that group health plans and health insurance issuers offering group or individual coverage must provide comprehensive benefits for services related to breast or chest wall reconstruction when furnished in connection with breast cancer treatment. The required coverage is extensive, encompassing **extirpation or medical treatment of diseased or damaged breast tissue**, including mastectomy and breast-conserving surgery. It mandates coverage for all modalities of breast reconstruction, such as **implant-based** and **tissue-based** methods, and specific types like **immediate or delayed implant reconstruction** and **microvascular free flap reconstruction**. Crucially, the bill also includes coverage for any new reconstruction modalities or types developed in the future and recognized by the Healthcare Common Procedure Coding System. Beyond reconstruction, the bill requires coverage for **flat closure**, surgery and reconstruction of the other breast or chest wall to achieve a **symmetrical appearance**, and **custom fabricated breast prostheses** including their replacement. It also covers mechanical, medical, and surgical treatment for **physical complications** arising from mastectomy, reconstruction, radiation, and lymph node surgery, including lymphedema compression treatment items. This ensures a holistic approach to post-cancer care. Health plans and issuers must provide this coverage in consultation with the patient's attending physician, allowing for standard deductibles and coinsurance consistent with other benefits. They are also required to ensure that at least one **in-network provider** is available for each covered modality, type, and procedural variation. The bill prohibits plans from denying eligibility to avoid these requirements or penalizing providers for delivering care consistent with the act and generally accepted medical standards, while also requiring written notice of these benefits to be provided to enrollees upon enrollment and annually thereafter.