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The Wagner Law Group Description 

The Wagner Law Group, A Professional Corporation, is a nationally recognized ERISA & employee benefits, estate planning, employment, labor & human resources practice. 

 

Established in 1996, The Wagner Law Group has 19 attorneys engaged exclusively in employee benefits, estate planning and employment law. Five of our attorneys are AV rated by Martindale-Hubbell as having very high to preeminent legal abilities and ethical standards. The firm is among the largest ERISA boutiques in the country. Our practice is national in scope, with clients in more than 40 states and several foreign countries.

 

 

 

 

 

Contact Info

The Wagner Law Group

 

Massachusetts Office 

Tel: (617) 357-5200 

Fax: (617) 357-5250 

99 Summer Street 

13th Floor

Boston, MA 02110


Florida Office 

Tel: (561) 293-3590
Fax: (561) 293-3591
7121 Fairway Drive
Suite 203
Palm Beach Gardens, FL 33418

 

New York Office

Tel: (716) 650-5987

Fax: (716) 633-0301

333 International Drive

Suite B-4

Williamsville, NY 14221

 

San Francisco Office

Tel: (415) 625-0002

Fax: (415) 829-4385

315 Montgomery Street

Suite 902

San Francisco, CA 94104

 

www.wagnerlawgroup.com

 

July 5, 2012 

 State and Federal Law Alert

 

 

 

 

 

 

Court Finds SPD  Satisfies Women's Health and

Cancer Rights Act Notice Requirements

 

 

 

 

A federal court recently decided that the administrator for a group health plan had satisfied its notice obligation under the Women's Health and Cancer Rights Act ("WHCRA") by annually providing participants with the plan's summary plan description ("SPD"), which contained a section explaining that the plan covered certain mastectomy-related benefits.

 

WHCRA requires group health plans and health insurers to provide coverage for reconstructive surgery related to a mastectomy.  Moreover, group health plans must provide participants with written notice of the availability of these benefits at the time of enrollment, and annually thereafter.  While the enrollment notice must include a specific description of the treatments covered, and any applicable deductibles or co-insurance limits, the annual notice need only inform participants about the availability of these benefits and explain how to obtain more information.

 

In the recent case, Haag v. MVP Healthcare, a plaintiff sued the claims administrator under her employer's self-insured health plan, claiming that the administrator had failed to provide her with the written notice required by WHCRA.  The plaintiff brought the lawsuit after the claims administrator refused to pay the full cost of her mastectomy-related reconstructive surgery.  The claims administrator responded by asking the court to dismiss the claim, asserting that it had satisfied its WHCRA notice obligations by including the required disclosures in the plan's SPD, which it distributed annually to plan participants.

 

The court reviewed the plan's SPD and determined that it provided participants with clear notice of the coverage required by WHCRA.  In particular, the court found that the SPD contained an entire sub-section entitled "Women's Health and Cancer Rights Act of 1998," which notified participants that the plan covered mastectomy-related reconstructive surgery.  Accordingly, the court determined that the claims administrator had satisfied its WHCRA notice obligation by distributing the SPD annually to participants and, thus, proceeded to dismiss the plaintiff's claim.

 

As the Haag case demonstrates, group health plans can satisfy their WHCRA annual notice obligations by furnishing the required disclosures in either a stand-alone document or the plan's SPD, so long as the SPD is distributed annually.  For more information about the WHCRA notice requirements, visit the U.S. Department of Labor's Frequently Asked Questions about Women's Health and Cancer Rights at: http://www.dol.gov/ebsa/faqs/faq_consumer_womenshealth.html.

 

    

 

 

 

 

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This Newsletter is provided for information purposes by The Wagner Law Group to clients and others who may be interested in the subject matter, and may not be relied upon as specific legal advice.  This material is not to be construed as legal advice or legal opinions on specific facts. Under the Rules of the Supreme Judicial Court of Massachusetts, this material may be considered advertising.