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 enrollment notice.

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.

The DOL has provided model notice language for plan sponsors to use:

If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the a ending physician and the patient, for:

These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan. Therefore, the following deductibles and coinsurance apply: [insert deductibles and coinsurance applicable to these benefits]. If you would like more information on WHCRA benefits, call your plan administrator [insert phone number].

According to DOL guidance, the WHCRA enrollment notice must be given "upon enrollment" in accordance with similar SPD disclosure regulations. This means the WHCRA enrollment notice must be provided within 90 days after someone becomes a participant—that is, within 90 days after initial enrollment in the plan. Because most new enrollees are new hires, it makes sense to include the WHCRA enrollment notice in the new hire notice packet, unless the notice is already included in another document being provided upon enrollment.

The WHCRA enrollment notice must be given to all new 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.

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.