Women's Health Rights and Cancer Act - Connecticut

Summary of differences between federal and state regulations

Employee health plans are generally covered under the federal jurisdiction of the Employee Retirement Income secuity 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 provisions are called out below, and represent where the state goes beyond the federal requirements under ERISA.

Effective October 1, 2005, in addition to mammograms required under §38a-530, the plan must cover ultrasound screenings if they are recommended by a physician. See Substitute Senate Bill No. 30.

State

Contact

Connecticut Insurance Department

Regulations

Connecticut Revised Statute §38a-530: Mandatory coverage for mammography
www.cga.ct.gov/2011/pub/Chap700c.htm#Sec38a-530.htm

Connecticut Revised Statute §38a-530a: Mandatory coverage for breast cancer survivors
www.cga.ct.gov/2011/pub/Chap700c.htm#Sec38a-530a.htm

Connecticut Revised Statute §38a-503b: Carriers to permit direct access to obstetrician-gynecologist
www.cga.ct.gov/2011/pub/Chap700c.htm#Sec38a-530b.htm

Connecticut Revised Statute §38a-530c: Mandatory coverage for maternity care. Notice required.
www.cga.ct.gov/2011/pub/Chap700c.htm#Sec38a-530c.htm

Connecticut Revised Statute §38a-530d: Mandatory coverage for mastectomy care. Termination of provider contract prohibited.
www.cga.ct.gov/2011/pub/Chap700c.htm#Sec38a-530d.htm

Connecticut Revised Statute §38a-542: Mandatory coverage for treatment of tumors and leukemia. Mandatory coverage for reconstructive surgery, prosthesis and chemotherapy. Mandatory coverage for breast reconstruction after mastectomy.
www.cga.ct.gov/2011/pub/Chap700c.htm#Sec38a-542.htm

Connecticut Revised Statute §38a-547: Termination of policy or contract due to insurer ceasing to offer health insurance in this state; maternity benefits to continue for six weeks following termination of the pregnancy, when.
www.cga.ct.gov/2011/pub/Chap700c.htm#Sec38a-547.htm

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)