WHCRA Notice

The Women's Health and Cancer Rights Act notice tells participants about their right to mastectomy-related reconstruction benefits under federal law. Required at enrollment and annually.

See the Step-by-Step ProcessView Model Notice
What A notice informing participants that if the plan covers mastectomies, it also covers related reconstruction and post-mastectomy care as required by WHCRA.
Who Group health plans that provide mastectomy coverage, self-funded or insured, including HMOs. Provide to all plan participants.
When At enrollment and at least annually thereafter (most employers include it with Open Enrollment materials).
Risk Up to $100 per affected beneficiary per day under IRC § 4980D for plan violations, including notice failures (statutory rate, not inflation-adjusted). The DOL also has independent enforcement authority under ERISA for notice failures. Both risks are easy to avoid; this is one of the simplest notices you'll send.
Enroll
Initial enrollment / eligibility

At or before enrollment. The enrollment notice must describe all four benefit categories and cost-sharing.

Annual
Annual reminder

Once each plan year, best bundled with Open Enrollment materials. The shorter one-paragraph format works here.

Trigger Due Date / Window Notes
Initial enrollment / eligibility At or before enrollment Include with the new-hire benefits packet or SPD delivery. The enrollment notice must describe all four benefit categories and applicable cost-sharing.
Annual reminder Once each plan year Best practice: bundle with Open Enrollment materials. The annual notice can be the shorter one-paragraph format.
Trigger: Initial enrollment / eligibility
Window: At or before enrollment
Notes: Include with the new-hire packet or SPD. Describe all four benefit categories and cost-sharing.
Trigger: Annual reminder
Window: Once each plan year
Notes: Bundle with Open Enrollment materials. The shorter one-paragraph format works.
  • Notice text: See the Model Notice section below, the DOL's sample language with [CUSTOMIZE] fields for your plan and administrator contact. The annual version is one paragraph; the enrollment version requires more detail on benefits and cost-sharing.
  • Plan documents: Your SPD/SMM language confirming WHCRA benefits are covered (reconstruction, symmetry procedures, prostheses, and treatment of complications including lymphedema) with cost-sharing no more restrictive than other medical/surgical benefits.
  • Administrator contact: Plan administrator phone number and claims contact; participants need to know who to call.
  • Languages: English plus any translations your workforce needs.
1
Draft the noticeUse the model language in the Model Notice section below. Fill in your plan name, administrator contact, and phone number. Use the shorter annual format for Open Enrollment; use the fuller enrollment version for new hires.
2
Confirm coverage termsEnsure your SPD and certificates of coverage reflect all four WHCRA benefit categories and that the applicable cost-sharing is no more restrictive than for other medical/surgical benefits.
3
DistributeProvide at enrollment and annually to all plan participants (paper or compliant e-delivery).
4
ArchiveSave the exact version used, date-stamped, with your distribution proof (see Proof & Recordkeeping).
  • Audience: All plan participants, and beneficiaries as applicable, covered under your group health plan.
  • Method: Paper or electronic delivery. If using email or a benefits portal, follow ERISA's e-disclosure safe harbor rules (employees must have consented or meet the electronic access criteria).
  • Clarity: Use plain language and make the plan administrator's contact information easy to find. Participants should know exactly who to call if they have a claim.
  • Notice copiesThe exact notice used each plan year, date-stamped, with a note of where it appeared (new-hire packet, OE guide, benefits portal page).
  • Distribution logsMailing list, date sent, and delivery method (paper or e-delivery). For paper mailings, retain a Certificate of Mailing (USPS Form 3817) as proof of dispatch; certified mail is not required.
  • E-delivery recordsPortal access timestamps or email delivery confirmations.
  • SPD/SMM pagesCurrent pages showing WHCRA benefits and the applicable cost-sharing terms.

Common traps

Assuming the carrier always sends it: The employer/plan administrator is responsible for ensuring delivery even for fully insured plans. Confirm with your carrier that the notice is going out and to whom.
Outdated SPD language: Language that doesn't clearly reflect all four WHCRA benefit categories or that imposes more restrictive cost-sharing than the plan's other medical/surgical benefits.
Skipping waived employees at enrollment: Include anyone who is eligible and receives plan materials, not just those who enroll.

FAQs

What services must be covered?
Post-mastectomy reconstruction on the affected breast, surgery on the other breast to produce a symmetrical appearance, prostheses, and treatment of physical complications of the mastectomy, including lymphedema. Cost-sharing (deductibles, coinsurance) must be no more restrictive than for other medical and surgical benefits.

Who should receive the WHCRA Notice?
All plan participants, and beneficiaries as applicable, covered under your group health plan. This includes participants who waived coverage at enrollment.

What's the penalty for not providing it?
Plan violations, including failing to provide the required notice, can trigger a $100 per affected beneficiary per day excise tax under IRC § 4980D (statutory rate, not adjusted for inflation). The DOL also enforces notice requirements independently under ERISA. The notice is one paragraph long; there's no good reason to skip it.

  • Insured plans: Carriers often supply WHCRA notice language; confirm it's in your Open Enrollment packet each year and that it goes to all eligible participants, not just enrollees.
  • Self-funded plans: You're responsible for both the notice and the underlying coverage requirements. Coordinate with your TPA to align SPD/SMM language and claims procedures with WHCRA.
  • State mandates: Some states impose additional mastectomy-related notice or coverage requirements beyond the federal minimum. Check the rules for every state where you have covered participants.

The DOL provides sample notice language you can use directly. The annual version is one sentence. Copy, customize the bracketed fields, and distribute.

Annual notice (one-paragraph format, use for Open Enrollment):

Did you know that your plan, as required by the Women's Health and Cancer Rights Act of 1998, provides benefits for mastectomy-related services including all stages of reconstruction and surgery to achieve symmetry between the breasts, prostheses, and complications resulting from a mastectomy, including lymphedema? Call [PLAN ADMINISTRATOR NAME] at [PHONE NUMBER] for more information.

Enrollment notice (more detail required for new participants): The enrollment notice must describe all four benefit categories (reconstruction, symmetry surgery, prostheses, and treatment of complications) plus the applicable cost-sharing terms (deductibles and coinsurance, which must be no more restrictive than for other medical/surgical benefits). See the DOL WHCRA FAQ below for the full enrollment notice template and guidance.

What to customize in the annual notice: Replace [PLAN ADMINISTRATOR NAME] with your plan administrator's name and [PHONE NUMBER] with their direct number. That's it.

DOL WHCRA FAQs (PDF): includes the full enrollment notice template and answers to common coverage questions.