Women's Health Rights and Cancer Act - Kentucky

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:

• Like the federal requirement, health plans that provide coverage for maternity services, including benefits for childbirth, must provide coverage for at least 48 hours of inpatient care following a normal delivery and at least 96 hours of inpatient care following delivery by caesarean section for a mother and newly born child. (§304.17A-145)
• Like the federal requirements, plans must make available and offer to the purchaser coverage for participants who are receiving benefits in connection with a mastectomy and who elect breast reconstruction in connection with such mastectomy, coverage for all stages of breast reconstruction surgery 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 all stages of mastectomy, including lymphedemas. (§304.17A-134 and §304.17-3163, §304.18-0983)
• Plans that cover mastectomies must also provide coverage for mammograms. The coverage includes one mammogram to women 35 through 39; one mammogram every two years for women 40 through 49; and one mammogram per year for women 50 and over; and may be limited to a benefit of $50 per mammogram. (§304.17A-133, §304.17-316, §304.18-098)
• Plans that cover treatment of breast cancer by chemotherapy must also cover treatment of breast cancer by highdose chemotherapy with autologous bone marrow transplantation or stem cell transplantation. (§304.17A-135, §304.17-3165, §304.18-0985)
• Optional coverage for endometriosis and endometritis if the plan also covers hysterectomies; and bone density testing for women 35 years and older, as indicated by the health-care provider to obtain baseline data for the purpose of early detection of osteoporosis. (§304.17-3163, §304.18-0983)
• Women must be allowed to identify a gynecologist as a primary care provider. A primary care physician treating a pregnant participant or has a chronic gynecological condition may refer her to a participating obstetrician or gynecologist. If referred the participant must have direct access to the obstetrician or gynecologist, without the need of further contact or referral by the primary care physician. The plan must covered annual pap smears performed by obstetricians or gynecologists without a referral from a primary care provider. (§304.17A-647)

State

Contact

Kentucky Department of Insurance

Regulations

Kentucky Revised Statutes

§304.17a-145:
www.lrc.ky.gov/Statutes/statute.aspx?id=17379

§304.17a-133:
www.lrc.ky.gov/Statutes/statute.aspx?id=17368

§304.17-316:
www.lrc.ky.gov/Statutes/statute.aspx?id=17326

§304.18-098:
www.lrc.ky.gov/Statutes/statute.aspx?id=29440

§304.17a-134:
www.lrc.ky.gov/Statutes/statute.aspx?id=17369

§304.17-3163:
www.lrc.ky.gov/Statutes/statute.aspx?id=17327

§304.17a-135:
www.lrc.ky.gov/Statutes/statute.aspx?id=17370

§304.17-3165:
www.lrc.ky.gov/Statutes/statute.aspx?id=17328

§304.18-0983:
www.lrc.ky.gov/Statutes/statute.aspx?id=29441

§304.18-0985:
www.lrc.ky.gov/Statutes/statute.aspx?id=29442

§304.17a-647:
www.lrc.ky.gov/Statutes/statute.aspx?id=29322

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)