Women's Health Rights and Cancer Act - Illinois

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:

• Treatment of infertility including, but not limited to, in vitro fertilization, uterine embryo lavage, embryo transfer, artificial insemination, gamete intrafallopian tube transfer, zygote intrafallopian tube transfer, and low tubal ovum transfer. 215 ILCS 5/356m
• Fibrocystic breast conditions. 215 ILCS 5/356n
• Breast implantremoval – when medically necessary. 215 ILCS 5/356p
• If the plan requires participants to designate an individual to coordinate care or to control access to health care services, it must also permit female participants to designate a participating woman's principal health care provider. The insurer or managed care plan must provide a written notice to all female participants, to all new enrollees at the time of enrollment, and to all existing enrollees at least annually, as a part of a regular publication or informational mailing. 215 ILCS 5/356r
• Mammograms – baseline for women 35-39 years old; annual for women 40 or more years old; and at the age and intervals medically necessary for women under 40 years of age and having a family history of breast cancer or other risk factors. 215 ILCS 5/356g
• Mastectomy provisions mirror those of the federal Women’s Health and Cancer Rights Act of 1998. 215 ILCS 5/356g, 215 ILCS 5/356t
• Hospital stays after delivery provisions mirror those of the federal Newborns’ and Mothers’ Health Protection Act of 1996. 215 ILCS 5/356s
• Annual pap tests; effective January 1, 2006, surveillance tests for ovarian cancer for female plan participants who are at risk for ovarian cancer. 215 ILCS 5/356u

State

Contacts

Department of Financial and Professional Regulation, Department of Insurance - Chicago

Department of Financial and Professional Regulation, Department of Insurance - Springfield

Regulations

215 ILCS 5/356 Illinois Insurance Code

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)