WHCRA provides that group health plans and health insurance issuers that provide coverage for medical and surgical benefits with respect to mastectomies must also cover certain post-mastectomy benefits.
Generally, group health plans, insurance companies and HMOs, that provide coverage for medical and surgical benefits with respect to a mastectomy must comply with WHCRA. However, certain plans, including church plans or governmental plans may not be subject to this law, womens health and cancer rights act.
For more information, womens health and cancer rights act, see Additional Resources for a link to the Department of Labor web site See Additional Resources for a link to the Department of Labor web site for more information. A notice must be provided to all employees at the time of enrollment in the health plan.
Deductibles and coinsurance limitations may be imposed only if they are consistent with those established for other benefits under the plan or coverage. An annual notice should be sent to all plan participants and should describe the coverage required under WHCRA and information on how to obtain a detailed description of the mastectomy-related benefits available under the plan.
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Specify coverage will be provided in a manner determined in consultation with the attending physician and the participant who will be receiving the mastectomy-related benefits. Describe any deductibles and coinsurance limitations that apply to the coverage specified under WHCRA.
Annual Notice An annual notice should be sent to all plan participants and should describe the coverage required under WHCRA and information on how to obtain a detailed description of the mastectomy-related benefits available under the plan.
The annual notice may be the same notice provided when the participant enrolled in the plan if it contains the information described above. The notice must be included in the Summary Plan Description and distributed annually to plan participants. If the SPD is distributed annually, then it satisfies the annual notice requirement.