Women's Health Rights and Cancer Act - Massachusetts

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 laws include the following provisions:

• Annual cytologic screening for women eighteen years of age and older (47G);
• A baseline mammogram for women between the ages of thirty-five and forty and for a mammogram on an annual basis for women forty years of age and older (47G);
• Prenatal, childbirth, and postpartum care benefits (47F);
• Certified nurse midwife services benefits (47E);
• Infertility, pregnancy-related benefits (47H);
• Bone marrow transplant or transplants for persons who have been diagnosed with breast cancer that has progressed to metastatic disease (47R).

State

Contact

Massachusetts Division of Insurance

Regulations

General Laws of Massachusetts

Chapter 175: https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXXII/Chapter175

Section 47E: https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXXII/Chapter175/Section47e

Section 47F: https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXXII/Chapter175/Section47f

Section 47G: https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXXII/Chapter175/Section47g

Section 47H: https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXXII/Chapter175/Section47h

Section 47R: https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXXII/Chapter175/Section47r

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)