WHCRA: What Employers Need to Know About Women's Health and Cancer Rights Act Compliance

Employee benefits compliance involves more than offering quality health coverage. Employers are also responsible for providing required notices that inform employees of their rights under federal law. One notice that is frequently overlooked is the WHCRA notice.

The Women's Health and Cancer Rights Act (WHCRA) requires certain health plans to provide coverage for reconstructive services following a mastectomy and mandates that participants receive notice of these rights. Failing to distribute the required notice can create compliance issues for employers and plan administrators.

In this article, we'll explain what WHCRA is, who must comply, what coverage is required, and how employers can meet their annual notice obligations.

What Is WHCRA?

The Women's Health and Cancer Rights Act (WHCRA) was enacted in 1998 to protect individuals who undergo mastectomies as part of breast cancer treatment. The law requires group health plans and health insurance issuers that provide mastectomy coverage to also cover certain reconstructive services related to the mastectomy.

The goal of WHCRA is to ensure individuals have access to medically necessary reconstruction and related treatments without facing discriminatory coverage limitations.

What Coverage Does WHCRA Require?

If a group health plan covers mastectomies, it must also provide coverage for:

Reconstruction of the Breast

Coverage must include reconstruction of the breast on which the mastectomy was performed.

Surgery on the Opposite Breast

The plan must cover surgery and reconstruction of the other breast to achieve a symmetrical appearance.

Prostheses

Coverage must include breast prostheses as determined by the attending physician and patient.

Treatment of Physical Complications

The plan must cover treatment for physical complications resulting from a mastectomy, including lymphedema when medically appropriate.

These services must be provided in consultation with the patient and their physician.

Who Must Comply with WHCRA?

WHCRA generally applies to:

• Employer-sponsored group health plans

• Fully insured group health plans

• Self-funded group health plans

• Health insurance issuers that provide mastectomy coverage

If a health plan offers mastectomy benefits, the WHCRA requirements typically apply regardless of employer size.

Is WHCRA Coverage Still a Concern for Employers?

In most cases, employers do not need to worry about whether their health plan includes WHCRA-required coverage. Today's group health plans that cover mastectomies generally include the reconstructive benefits required under federal law.

The more common compliance issue is not the coverage itself—it's the required notice. Employers are responsible for informing plan participants of their WHCRA rights at enrollment and annually thereafter. Unfortunately, this notice is one of several compliance requirements that can easily be overlooked during open enrollment or annual benefits administration.

For this reason, employers should focus on verifying that the WHCRA notice is included in their annual benefits communications and compliance procedures.

WHCRA Notice Requirements

One of the most important compliance obligations under WHCRA is the distribution of participant notices.

Employers must provide a notice informing participants about their rights under WHCRA:

At Enrollment

Participants should receive the WHCRA notice when they first enroll in the health plan.

Annually Thereafter

Employers must also provide the notice on an annual basis to remind participants of their rights.

Many employers satisfy this requirement by including the notice within:

• Summary Plan Descriptions (SPDs)

• Wrap plan documents

• Annual open enrollment materials

• Other required employee benefit communications

However, simply assuming the notice is included may not be enough. Employers should verify that the WHCRA notice is actually being distributed each year as part of their compliance process.

Why WHCRA Notices Are Often Overlooked

Unlike major compliance obligations such as COBRA, ACA reporting, or HIPAA privacy requirements, WHCRA notices often receive less attention.

Common reasons employers miss the notice include:

• Relying on outdated enrollment materials

• Assuming insurance carriers handle all notice obligations

• Failing to review annual compliance checklists

• Not updating SPDs or wrap documents regularly

Because the notice requirement is relatively simple, it can be easy to overlook during busy open enrollment periods.

Best Practices for Employers

To help maintain compliance with WHCRA, employers should:

Review Plan Documents Annually

Confirm that your SPD or wrap document includes the current WHCRA language.

Verify Distribution Procedures

Ensure enrollment packets, open enrollment communications, or annual benefit notices contain the required notice.

Coordinate with Benefits Advisors

Work with your benefits consultant, broker, or compliance partner to confirm all required notices are being distributed properly.

Maintain Documentation

Keep records showing when and how notices were distributed to employees and plan participants.

How DK Benefits Helps Employers Stay Compliant

Managing employee benefits compliance can be overwhelming, especially when employers must keep track of multiple federal notice requirements throughout the year.

At DK Benefits, we help employers stay on top of important compliance obligations, including WHCRA notices, HIPAA Special Enrollment Notices, Medicare Part D notices, CHIP notices, and other required employee benefits communications.

Our team works with employers to help ensure required notices are distributed properly and that benefit plans remain aligned with applicable regulations. Rather than wondering whether a notice was overlooked, employers can have confidence that key compliance requirements are being addressed.

How WHCRA Fits Into Your Compliance Strategy

WHCRA is only one of several federal notice requirements that employers must manage each year. Other commonly required notices may include:

• HIPAA Special Enrollment Notice

• Medicare Part D Creditable Coverage Notice

• CHIP Notice

• COBRA General Notice

• Summary of Benefits and Coverage (SBC)

Reviewing these notices as part of an annual compliance audit can help reduce risk and ensure employees receive the information they are entitled to under federal law.

Check Your Compliance Status

Wondering whether your employee benefits program is meeting federal notice requirements?

Take our Compliance Quiz to learn more about your compliance obligations and identify potential gaps. After completing the quiz, you'll gain access to helpful compliance resources, including links to required notices such as WHCRA and other important employee benefits disclosures.

It's a simple way to better understand your responsibilities and take proactive steps toward compliance.

Conclusion

The WHCRA provides important protections for individuals undergoing mastectomy treatment by ensuring access to reconstructive surgery and related medical services. For employers, compliance involves more than offering the required coverage—it also means providing timely notice of these rights to plan participants.

While most modern health plans already include the coverage required by WHCRA, employers should not overlook the notice requirement. Verifying that WHCRA notices are distributed at enrollment and annually can help prevent compliance gaps and reduce the risk of missed obligations.

Working with a knowledgeable benefits advisor such as DK Benefits can help employers stay informed, maintain compliance, and navigate the many notice requirements that come with sponsoring a group health plan.