- Health Benefits Advisor for Employers
Determining Compliance with the WHCRA Provisions in Part 7 of ERISA
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.