['Employee Benefits']
["Women's Health Rights and Cancer Act"]
06/11/2024
...
SEARCH
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 a plan containing maternity benefits discontinues and is replaced through a succeeding insurer; the succeeding insurer's policy may not contain a preexisting condition limitation for maternity or exclude coverage due to pregnancy for employees or spouses of employees who were covered under the prior policy on the date the prior plan was discontinued. This applies if the employer obtains a new group insurance policy within 31 days after the discontinuance of an insurance policy. (§27-8-5-25)
- Post-mastectomy coverage following the federal requirements; the state laws don’t provide as much as federal (they don’t provide for the treatment of physical complications of mastectomy, including lymphedemas). (§27-8-5-26)
- Coverage for services related to breast cancer screening. This includes baseline mammogram for women 35-40 years old, annual mammograms for women over 40 or at risk, mammograms or ultrasounds as determined medically necessary by the treating physician. (§27-8-14-6)
- Maternity benefits include parent education, assistance and training in breast or bottle feeding; routine maternal and neonatal tests, and minimum postpartum hospital stay recommended by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists in their Guidelines for Perinatal Care – unless otherwise directed by attending physician. (§27-8-24)
- The right to indicate a women’s heath care provider as the primary care physician. (§27-8-24.7)
State
Contact
Indiana Department of Insurance
Regulations
Indiana Code, Title 27, Article 8, Chapter 5
Indiana Code, Title 27, Article 8, Chapter 14
Indiana Code, Title 27, Article 8, Chapter 24
Indiana Code, Title 27, Article 8, Chapter 24.7
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)
READ MORESHOW LESS
['Employee Benefits']
["Women's Health Rights and Cancer Act"]
Load More
J. J. Keller is the trusted source for DOT / Transportation, OSHA / Workplace Safety, Human Resources, Construction Safety and Hazmat / Hazardous Materials regulation compliance products and services. J. J. Keller helps you increase safety awareness, reduce risk, follow best practices, improve safety training, and stay current with changing regulations.
Copyright 2024 J. J. Keller & Associate, Inc. For re-use options please contact copyright@jjkeller.com or call 800-558-5011.