U.S. Department of Labor
Health Benefits Advisor for Employers
Determining Compliance with the WHCRA Provisions in Part 7 of ERISA
Plan Compliance Results
Remember, for participants or beneficiaries of your health plan receiving benefits in connection with a mastectomy, your plan must offer coverage for the following benefits in a manner determined in consultation with the attending provider and the patient.
- All stages of reconstruction of the breast on which the mastectomy has been performed;
- Surgery and reconstruction of the other breast to produce a symmetrical appearance;
- Prostheses; and
- Treatment of physical complications of mastectomy, including lymphedemas.
These required coverages can be subject to annual deductibles and coinsurance provisions if consistent with those established for other medical/surgical benefits under the plan or coverage.
In order to comply with the WHCRA, your plan must offer all of the benefits above.
Based on your responses, your plan appears to be in compliance with the following WHCRA provisions:
- None.
Based on your responses, your plan does NOT appear to be in compliance with the following WHCRA provisions:
Note: If you would like to review the information provided within this Advisor, you may select that issue above and it will take you back to that section in the Health Benefits Advisor where you can reread the description and answer the question again. This Advisor provides general guidance and users are encouraged to review their specific health plan or health plan options in conjunction with the general information provided. In addition, the Advisor does not address health benefits offered through Federal, state, or local government plans or church plans.
Determine compliance with other applicable ERISA Laws:
The following health laws under Title I of ERISA may apply to your employer sponsored group health plan. You may select the following laws to determine compliance.
- Consolidated Omnibus Budget Reconciliation Act (COBRA)
- Health Insurance Portability and Accountability Act (HIPAA)
- Mental Health Parity Act (MHPA) and Mental Health Parity and Addiction Equity Act (MHPAEA)
- Newborns' and Mothers' Health Protection Act (Newborns' Act)
- Genetic Information Nondiscrimination Act (GINA)
- Michelle's Law
For more information on WHCRA visit:
- Compliance Assistance Guide
- WHCRA Self-Audit Checklist for Employers
- Women's Health and Cancer Rights Act of 1998
- Fact Sheet
- Chart of Required Notices
- Model Notices
- Statute
For more information on Compliance Assistance visit:
The Affordable Care Act (ACA) provides additional health protections. This website does not reflect the passage of the ACA. For an overview of the Affordable Care Act, please visit the ACA Summary. For regulations, guidance and additional information, please visit the Department of Labor's ACA webpage.
