U.S. Department of Labor
Health Benefits Advisor for Employers
Determining Compliance with the WHCRA Provisions in Part 7 of ERISA
Incentive Provisions
Does the plan comply with WHCRA by not providing impermissible incentives or penalties with respect to patients or attending providers?
A plan may not deny a patient eligibility to enroll or renew coverage solely to avoid WHCRA's requirements under ERISA section 713(c)(1).
In addition, under ERISA section 713(c)(2), a plan may not penalize or offer incentives to an attending provider to induce the provider to furnish care in a manner inconsistent with WHCRA.
