Insured or self-funded, the federal duty is the same. The backstop is not.
WHCRA binds both funding types, but state law, notice logistics and enforcement look different depending on who carries the risk. This page covers who answers for compliance and who can enforce the law.
Context For This Page.
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.
WHCRA Enrollment and Annual Notice Requirements
How the notices get delivered under each funding type.
WHCRA Language in the Plan Document, SPD and Certificate
What the documents should say about funding.
The Carrier Is Bound Too.
Section 2727 of the Public Health Service Act, 42 U.S.C. 300gg-27, applies the WHCRA rules to group health plans and to health insurance issuers, in both the group and individual markets. In an insured plan, that means the carrier and the employer’s plan are each subject to the rules.
The Department of Labor adds two practical points. Insured coverage may also carry state-law protections that go further than the federal law, with minimum hospital stays as the example it gives. And the plan meets its notice duty for a participant if the issuer timely provides the required notice. Neither point removes the employer’s need to confirm the notice actually went out.
The Federal Law Is The Whole Rule.
The Department’s FAQ states that self-insured plans are governed only by the federal WHCRA and not by state law, because the employer funds the benefits directly. For a self-funded employer, the stack of responsibilities lands in one place: plan design, claim payment, the notices and the documents.
If a third-party administrator runs claims, the contract should say whether the administrator sends the annual notice, and the employer should keep proof. The Department notes that a plan can contract with another party to provide the notice, which is how most self-funded plans delegate it, though the duty itself stays with the plan.
What Section 713(e) Preserves.
The statute says it does not preempt state laws in effect on October 21, 1998 that require at least as much coverage of reconstructive breast surgery after a mastectomy, and that it does not change ERISA section 514 as applied to group health plans. Put simply, an insured plan can be subject to a state rule that gives more protection.
We have not verified any Michigan statute on this subject, so this page makes no Michigan-specific claim. An insured employer should ask the carrier which state requirements it applies to the policy.
Church And Governmental Plans.
The Department of Labor FAQ and consumer publication say that certain church or governmental plans may not be subject to WHCRA and that participants should check with the plan administrator. We have not reviewed the specific exemption rules, so a church or governmental plan sponsor should confirm its own status before relying on the point.
Who Can Enforce The Law.
The Department of Labor compliance guide describes enforcement of the Part 7 health laws generally. The Secretary of Labor enforces the ERISA requirements for private-sector group health plans. Participants and beneficiaries can sue both plans and issuers to enforce their rights under ERISA. The Secretary of the Treasury enforces parallel requirements under the Internal Revenue Code, where a taxpayer that fails to comply may face excise taxes or penalties. States enforce requirements against health insurance issuers.
That describes the framework, not a WHCRA penalty schedule. We did not find a WHCRA-specific penalty amount in the primary sources we reviewed, and we have not confirmed that a Code excise tax applies to WHCRA, so this page gives no dollar figures. For an actual compliance problem, speak with benefits counsel.
The practical exposure is usually a participant claim for a denied benefit. Clean documents, a documented notice routine and a clear claims process are the best defense.
Related Rules And Tools.
ERISA Part 7 Group Health Plan Requirements Checklist
The other federal health plan mandates that sit beside WHCRA.
Self-Funded Health Plans for 50 to 500 Employees
When funding claims directly can fit a mid-sized group.
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.
PHSA section 2727, 42 U.S.C. 300gg-27: Applies the same rules to group health plans and to issuers in the group and individual markets.
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, Your Rights After a Mastectomy: The participant-facing publication on what the law covers and where to get help.
General information, not legal or tax advice.
Quick Answers.
Short replies on responsibility and enforcement, each tied to a fuller page.
Does state law apply to our self-funded plan?
The Department of Labor FAQ says self-insured plans are governed only by the federal WHCRA, not state law. Insured plans may also be subject to state requirements.
Who can enforce WHCRA against an employer plan?
According to the Department of Labor guide, the Secretary of Labor enforces ERISA for private-sector group health plans, and participants and beneficiaries can sue plans and issuers. Treasury and the states have roles under the Code and for issuers.
What is the penalty for missing the annual notice?
We did not find a WHCRA-specific penalty amount in the primary sources we reviewed, so we do not state one. Ask benefits counsel about exposure for a specific missed notice.
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 Enrollment and Annual Notice Requirements
The enrollment notice and the annual notice.
WHCRA Language in the Plan Document, SPD and Certificate
What the plan document, SPD and certificate should say.
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