What Is It?
The Women's Health and Cancer Rights Act (WHCRA) requires group health plans to provide benefits for reconstructive surgery if the plan provides medical and surgical benefits for mastectomy, which most group health plans do. DOL interprets WHCRA as requiring that plans provide two separate notices: an enrollment notice and an annual notice. This post concerns the annual notice.
Who Is Required to Provide It?
The law requires both the plan itself and any health insurance company providing insured major medical benefits to provide the notice. Plans that are fully insured could rely on the insurer to handle this notice, but a careful employer will make sure the insurance company is timely providing both types of notices. Self-insured plans are all on their own to ensure compliance with WHCRA's notice requirements.
What Must it Say?
The DOL has provided a simple model notice language for plan sponsors to use:
Do you know that your plan, as required by the Women’s Health and Cancer Rights Act of 1998, provides benefits for mastectomy-related services including all stages of reconstruction and surgery to achieve symmetry between the breasts, prostheses, and complications resulting from a mastectomy, including lymphedema? Call your plan administrator at [insert phone number] for more information.
When Must it Be Given?
ERISA requires that the WHCRA annual notice be given "as part of any yearly informational packet sent to the participant or beneficiary"—i.e., in open enrollment materials.
To Whom?
The WHCRA annual notice must be given to all employee-participants and to dependent/spouse beneficiaries when the plan sponsor or the plan administrator knows that the address of a beneficiary is different than the last known address of the employee-participant.
How May it Be Delivered?
The WHCRA enrollment notice may be provided either by mail, in person or electronically in accordance with the DOL electronic delivery safe harbor for SPDs.