Women's Health Rights and Cancer Act - Idaho

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:

Idaho statutes provide for involuntary complications of pregnancy. Elective abortions are not covered. If the individual has not other coverage continuance, policies must provide that benefits will be payable to the same extent as if discontinuance had not occurred for any covered benefits in connection with such pregnancy, childbirth or miscarriage, but not beyond 12 months after the discontinuance.

Group policies must provide for mammograms as follows:

• A baseline mammogram for women 35 through 39 years old;
• A mammogram every two years for women 40 through 49 years old, or more frequently if recommended by the womens’ physician;
• A mammogram every year for women 50 years old or older; and
• A mammograms for women desiring a mammogram for medical cause.

Health care contracts or other marketing documents describing health care services offered by any managed care organization must allow members direct access to network obstetricians and gynecologists for maternity care, annual visits, and follow-up gynecological care for conditions diagnosed during maternity care or annual visits.

State

Contact

Department of Insurance

Regulations

Idaho statutes (copyrighted),

§41-2210 (complications of pregnancy)

§41-2210A (elective abortions)

§41-2214 (maternity)

§41-2218 (mammograms)

§41-3915 (access to OB/GYN)

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)