Women's Health Rights and Cancer Act - South Dakota

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:

• Unless the plan provides coverage for specified disease or other limited benefit coverage, it must cover mammograms as follows: ages 35 to 39, one baseline mammography; ages 40 to 49, a mammography every other year; and age 50 and older, a mammography every year. Coverage must be subject to the same dollar limits, deductibles, and coinsurance factors as for other radiological examinations. (§58-17-1.1, §58-18-36)
• If the plan provides maternity coverage, it must provide coverage for a minimum of 48 hours of inpatient care following a vaginal delivery and a minimum of 96 hours of inpatient care following delivery by cesarean section for a mother and her newborn child in a health care facility. (§58-17-88, §58-18-76)
• If the treating physician determines that the mother and the newborn meet medical criteria, the plan may provide coverage for a shorter length of hospital inpatient stay for services related to maternity and newborn care than is required in §58-17-88 if the coverage includes one follow-up visit in the first 48 hours after discharge to verify the condition of the mother and newborn. (§58-17-89, §58-18-77)

State

Contact

South Dakota Department of Revenue and Regulation, Division of Insurance

Regulations

South Dakota Statute

Title 58 Insurance

Chapter 58-17 Health Insurance Policies

§58-17-1.1 Grandfathered plans required to cover low-dose mammography—Extent of coverage.

§58-17-88 Minimum inpatient care coverage following delivery.

§58-17-89 Shorter hospital stay permitted--Follow-up visit within forty-eight hours required.

Chapter 58-18 Group and Blanket Health Insurance Policies

§58-18-36 Grandfathered plans required to cover low-dose mammography—Extent of coverage.

§58-18-76 Minimum inpatient care coverage following delivery.

§58-18-77 Shorter hospital stay permitted—Follow-up within forty-eight hours required.

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)