I 
109TH CONGRESS 
1ST SESSION 
H. R. 437
To amend the Internal Revenue Code of 1986 to require group health plans 
to provide coverage for reconstructive surgery following mastectomy, con-
sistent with the Women’s Health and Cancer Rights Act of 1998. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 1, 2005
Mrs. KELLY introduced the following bill; which was referred to the 
Committee on Ways and Means 
A BILL 
To amend the Internal Revenue Code of 1986 to require 
group health plans to provide coverage for reconstructive 
surgery following mastectomy, consistent with the Wom-
en’s Health and Cancer Rights Act of 1998.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Women’s Health and 
Cancer Rights Conforming Amendments of 2005’’.
SEC. 2. CONFORMING THE INTERNAL REVENUE CODE OF 
1986 TO REQUIREMENTS IMPOSED BY THE 
WOMEN’S HEALTH AND CANCER RIGHTS ACT 
OF 1998. 
(a) IN GENERAL.—Subchapter B of chapter 100 of 
the Internal Revenue Code of 1986 (relating to other re-
quirements) is amended by inserting after section 9812 
the following new section: 
‘‘SEC. 9813. REQUIRED COVERAGE FOR RECONSTRUCTIVE 
SURGERY FOLLOWING MASTECTOMIES. 
‘‘(a) IN GENERAL.—A group health plan that pro-
vides medical and surgical benefits with respect to a mas-
tectomy shall provide, in a case of a participant or bene-
ficiary who is receiving benefits in connection with a mas-
tectomy and who elects breast reconstruction in connection 
with such mastectomy, coverage for—
‘‘(1) all stages of reconstruction of the breast 
on which the mastectomy has been performed, 
‘‘(2) surgery and reconstruction of the other 
breast to produce a symmetrical appearance, and 
‘‘(3) prostheses and physical complications of 
mastectomy, including lymphedemas, 
in a manner determined in consultation with the attending 
physician and the patient. Such coverage may be subject 
to annual deductibles and coinsurance provisions as may 
be deemed appropriate and as are consistent with those
established for other benefits under the plan. Written no-
tice of the availability of such coverage shall be delivered 
to the participant upon enrollment and annually there-
after. 
‘‘(b) PROHIBITIONS.—A group health plan may not—
‘‘(1) deny to a patient eligibility, or continued 
eligibility, to enroll or to renew coverage under the 
terms of the plan, solely for the purpose of avoiding 
the requirements of this section, and 
‘‘(2) penalize or otherwise reduce or limit the 
reimbursement of an attending provider, or provide 
incentives (monetary or otherwise) to an attending 
provider, to induce such provider to provide care to 
an individual participant or beneficiary in a manner 
inconsistent with this section. 
‘‘(c) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to prevent a group health plan 
from negotiating the level and type of reimbursement with 
a provider for care provided in accordance with this sec-
tion.’’
(b) CLERICAL AMENDMENT.—The table of sections 
for chapter 100 of such Code is amended inserting after 
the item relating to section 9812 the following new item:
‘‘Sec. 9813. Required 
coverage 
for 
reconstructive 
surgery 
following 
mastectomies.’’
(c) EFFECTIVE DATE.—
(1) IN GENERAL.—The amendments made by 
this section shall apply with respect to plan years be-
ginning on or after the date of enactment of this 
Act. 
(2) SPECIAL
RULE
FOR
COLLECTIVE
BAR-
GAINING
AGREEMENTS.—In the case of a group 
health plan maintained pursuant to 1 or more collec-
tive bargaining agreements between employee rep-
resentatives and 1 or more employers, any plan 
amendment made pursuant to a collective bargaining 
agreement relating to the plan which amends the 
plan solely to conform to any requirement added by 
this section shall not be treated as a termination of 
such collective bargaining agreement.
Æ