Two written notices, and the law does not let a plan skip either one.
Plans must tell participants about mastectomy-related benefits when they enroll and once a year after that. This page covers what each notice must say, who can send it and how it reaches people.
Read These Together.
General information, not legal advice. Each page cites the statute or Department of Labor source it relies on.
WHCRA: Women’s Health and Cancer Rights Act Guide
The overview of the law and the five topics around it.
What WHCRA Requires a Plan to Cover After a Mastectomy
The four benefits the notices have to describe.
WHCRA Language in the Plan Document, SPD and Certificate
Where the notice language belongs in plan documents.
Enrollment And Every Year After.
ERISA section 713, 29 U.S.C. 1185b, requires written notice of the required coverage at enrollment and annually afterward. The Department of Labor compliance guide repeats it: written notice about the availability of these benefits must reach participants in a group health plan upon enrollment and then each year.
The sources we read set the frequency as once each year. We did not find a prescribed calendar date for the annual notice, so the date is a plan decision. Many plans fold it into the open enrollment packet, which is a practical choice, not a rule we found stated.
What The First Notice Must Say.
According to the Department of Labor guide, the enrollment notice must state that, for an individual receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient for four things: all stages of reconstruction of the breast on which the mastectomy was performed, surgery and reconstruction of the other breast for a symmetrical appearance, prostheses, and treatment of physical complications of the mastectomy, including lymphedema.
It must also describe any deductibles and coinsurance limitations that apply to that coverage. The guide’s model enrollment notice has a blank for those amounts and a blank for the plan administrator’s phone number, which tells you the Department expects the actual figures to be filled in, not left generic.
What The Yearly Reminder Must Say.
The annual notice must describe the four categories of coverage and explain how to get a detailed description of the plan’s mastectomy-related benefits. The guide’s model annual notice is short, a few sentences that name the four categories and point the reader to the plan administrator.
A plan can satisfy the annual duty by sending the same notice it used at enrollment, as long as that notice contains the information the annual notice needs. One notice written well can therefore do both jobs.
Who Sends It And How.
The guide says the notices must be delivered under the Department of Labor disclosure rules for furnishing Summary Plan Descriptions. First class mail is one example, and the guide refers to other delivery methods allowed by that regulation. We did not independently review the delivery regulation for this page, so confirm the electronic delivery conditions before relying on email alone.
A separate notice must go to a beneficiary whose last known address differs from the participant’s. To avoid duplicate mailings, a plan can contract with another party to send the notice. For an insured plan, the plan meets its duty for a participant if the issuer timely sends a notice with the required information. For a self-funded plan, the sponsor or its administrator needs to confirm who is sending it and keep proof.
Section 713(b) also says the notice should be prominently placed in plan literature or correspondence, so a buried line in a long booklet is a weak approach.
A Simple Notice Routine.
Put the enrollment notice in the new-hire packet and the annual notice in the same place every year. Keep a dated copy of each version, and record who sent it. If the carrier mails the annual notice, ask for a copy of the notice and the mailing date rather than assuming it went out.
Related Rules And Tools.
Michelle’s Law and Dependent Student Coverage
Another Part 7 rule that employers administer alongside WHCRA.
ERISA Part 7 Group Health Plan Requirements Checklist
The other federal health plan mandates that sit beside WHCRA.
A Compliance Calendar for Your Plan Year
A plan-year view of the dates that matter.
Laws And Sources
ERISA section 713, 29 U.S.C. 1185b: The statute: required coverage, notice, prohibited practices and the state-law savings clause.
DOL, Health Benefits Coverage Under Federal Law: The compliance guide with the WHCRA questions and answers, the model enrollment notice, the model annual notice and the Part 7 enforcement discussion.
DOL, FAQs About Women’s Health and Cancer Rights: Plain answers on notice content, cost-sharing, insured and self-insured plans and exempt plans.
DOL EBSA, Women’s Health and Cancer Rights Act: The Department of Labor page with the fact sheet, the FAQs and the consumer publication.
General information, not legal or tax advice.
Quick Answers.
Short replies on the notice rules, each tied to a fuller page.
Can the same notice serve as both the enrollment and annual notice?
Yes, according to the Department of Labor guide, if the notice includes the information an annual notice must contain: the four categories of coverage and how to get a detailed description of the benefits.
Does an insured plan have to send its own notice if the carrier sends one?
The Department of Labor guide says an insured plan satisfies the duty for a participant if the issuer timely provides a notice with the required information. Keep proof that it was sent.
Is there a model notice we can use?
Yes. The Department of Labor compliance guide includes a model enrollment notice and a model annual notice that plans may use as a guide.
The Rest Of This Series.
WHCRA: Women’s Health and Cancer Rights Act Guide
The overview of the law and where each topic lives.
What WHCRA Requires a Plan to Cover After a Mastectomy
The four required benefits and who can claim them.
WHCRA Deductibles, Coinsurance and Plan Limits
Deductibles, coinsurance and the limits that are not settled.
WHCRA for Insured and Self-Funded Plans and Enforcement
Who answers for the notice and who can enforce it.
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