WHCRA Coverage Requirements
WHCRA requires group health plans that cover mastectomy to also cover: (1) reconstruction of the breast on which the mastectomy was performed; (2) surgery and reconstruction of the other breast to produce a symmetrical appearance; (3) prostheses; and (4) treatment of physical complications of mastectomy, including lymphedema. Coverage must be provided in a manner determined in consultation with the attending physician and the patient.
Notice Requirements
Plans must provide a WHCRA notice at enrollment and annually. The notice must describe the WHCRA coverage requirements. The notice can be included in the SPD, open enrollment materials, or as a standalone document. The notice must be provided to all plan participants — not just women.
Model Notice
Pro Tip
The DOL provides a model WHCRA notice that plans can use to satisfy the notice requirement. Using the model notice provides a safe harbor against penalties for inadequate notice content. Customize the model notice with your plan's specific contact information and include it in your annual open enrollment materials.