Women's Health Rights and Cancer Act - District of Columbia

Summary of differences between federal and state regulations

Employee health plans are generally covered under the federal jurisdiction of the Employee Retirement Income Security Act (ERISA). Laws for women specifically include the Women’s Health and Cancer Rights Act of 1998, and Newborns’ and Mothers’ Health Protection Act of 1996. State insurance laws, however, do apply. The federal laws regarding women’s health rights include the following provisions:

• If the plan covers mastectomies, it must cover all stages of reconstruction of the breast on which the mastectomy has been performed; surgery and reconstruction of the other breast to produce a symmetrical appearance; and prostheses and physical complications of mastectomy, including lymphedemas in a manner determined in consultation with the attending physician and the patient. (Women’s Health Rights and Cancer Act)
• If the group health plan provides maternity coverage, it must cover at least a 48-hour hospital stay following childbirth (96-hour stay in the case of Cesarean section). (Newborns' and Mothers' Health Protection Act)

The state has its own statutes governing breast reconstruction after mastectomies, in regard to new mothers; but they are similar to the federal requirements under the Women’s Health and Cancer Rights Act of 1998 and the Newborns’ and Mothers’ Health Protection Act of 1996.

The state also has laws governing cancer screening for women. These involve mammograms and cervical cytologic screenings.

However, the state laws provide for hormone replacement therapy if the plan covers prescriptions. It also has provisions for pre-delivery care, and, if a mother is discharged early from the hospital, for coverage for post-delivery care.

State

Contact

Department of Insurance, Securities, and Banking

Regulations

Title 31 (Insurance and Securities), Subtitle IV (Health and related insurance), Chapter 29 (Cancer prevention)

Breast reconstruction §31-3832

Hormone replacement §31-3834

New mothers §31-3802.01

Cancer screening §31-2902

Federal

Contact

Employee Benefits Security Administration (EBSA)

Regulations

See the text of the Women’s Health and Cancer Rights Act under Acts/Laws, Title 1, Subtitle B, Part 7, Subpart B; and the U.S. Code, Title 29, chapter 18, §1185b.

See also U. S. Code Title 29, chapter 18, §1185 for laws regarding mothers.

29 CFR 1604.10 (Employment policies relating to pregnancy and childbirth)

29 CFR chapter XXV (Parts 2509 – 2590)