|- Health Benefits Advisor for Employers|
Determining Compliance with the WHCRA Provisions in Part 7 of ERISA
Four Required Coverages under WHCRA
Does the plan provide the four coverages required by WHCRA?
In the case of a participant or beneficiary who is receiving benefits in connection with a mastectomy, the plan shall provide coverage for the following benefits for individuals who elect them:
These required coverages can be subject to annual deductibles and coinsurance provisions if consistent with those established for other medical/surgical benefits under the plan or coverage.
Tip: Plans that cover benefits for mastectomies cannot categorically exclude benefits for reconstructive surgery or certain post-mastectomy services. In addition, time limits for seeking treatment may run afoul of the general requirement to provide the four required coverages.