Women's Health Rights and Cancer Act - Nevada

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:

• If the plan covers gynecological or obstetrical services, it must allow women to obtain services without first receiving authorization or a referral from her primary care physician. §689B.031
• The plan must cover annual cytologic screening test for women 18 years of age or older. §689B.0374
• The plan must cover a baseline mammogram for women between the ages of 35 and 40, and annual mammograms for women 40 years of age or older. §689B.0374
• If the plan covers mastectomies, it must cover reconstruction of the breast on which the mastectomy has been performed, surgery and reconstruction of the other breast to produce a symmetrical structure, and prostheses and physical complications for all stages of mastectomy, including lymphedemas. §689B.0375
• The plan may not exclude, reduce or otherwise limit coverage relating to complications of pregnancy, unless such limit applies generally to all benefits payable under the policy. §689B.260
• If the plan covers maternity care and pediatric care for newborn infants, like the federal law, it must not restrict a hospital stay in connection with childbirth for a mother or newborn infant covered by the plan or coverage to less than 48 hours after a normal vaginal delivery; and less than 96 hours after a cesarean section. §689B.520

State

Contacts

Nevada Division of Insurance – Carson City

Nevada Division of Insurance – Las Vegas

Regulations

Nevada Revised Statutes:

Title 57 Insurance, Chapter 689B Group and Blanket Health Insurance;

§689B.0375 Required provision concerning coverage relating to mastectomy.

§689B.260 Required provision concerning coverage relating to complications of pregnancy.

§689B.520 Group plan or coverage that includes coverage for maternity care and pediatric care: Required to allow minimum stay in hospital in connection with childbirth; prohibited acts.

§689B.0374 Required provision concerning coverage for cytologic screening tests and mammograms for certain women.

§689B.031 Required provision concerning coverage of certain gynecological or obstetrical services without authorization or referral from primary care physician.

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)