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Compliance Assistance Resources

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- Health Benefits Advisor for Employers

Determining Compliance with the WHCRA Provisions in Part 7 of ERISA

Enrollment Notice

Does the plan provide adequate and timely enrollment notices as required by WHCRA?

Upon enrollment, a plan must provide a notice describing the benefits required under WHCRA. See ERISA section 713(a).

The enrollment notice must describe the benefits that WHCRA requires the group health plan to cover, specifically:

  • All stages of reconstruction of the breast on which the mastectomy was performed,
  • Surgery and reconstruction of the other breast to produce a symmetrical appearance,
  • Prostheses, and
  • Physical complications resulting from mastectomy (including lymphedema).

The enrollment notice must describe any deductibles and coinsurance limitations applicable to such coverage. (Note: Under WHCRA, coverage of the required benefits may be subject only to deductibles and coinsurance limitations consistent with those established for other medical/surgical benefits under the plan or coverage.)

Tip: A model notice is provided by EBSA.