Women's Health Rights and Cancer Act - Michigan

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 the plan covers hospital, medical, or surgical expenses, it must cover prosthetic devices to maintain or replace the body parts of an individual who has undergone a mastectomy. §500.3406a, §500.3613
• If the plan covers hospital, medical, or surgical expenses, it must offer or include coverage for breast cancer diagnostic services, breast cancer outpatient treatment services, and breast cancer rehabilitative services. §500.3406d, §500.3616
• If the plan covers hospital, medical, or surgical expenses, it must cover breast cancer screening mammography one mammogram for women from 35 to 40 years old, during that five-year period; an annual mammogram for women 40 years old or older. §500.3406d, §500.3616
• If the plan covers hospital, medical, or surgical expenses, requires an insured to designate a participating primary care provider, and provides for annual well-woman examinations and routine obstetrical and gynecologic services, it must allow a female insured to access an obstetrician-gynecologist for annual well-woman examinations and routine obstetrical and gynecologic services without prior authorization if the obstetrician-gynecologist is a participant. §500.3406m
• If the plan covers hospital, medical, or surgical expenses and covers obstetrical and gynecological services, it must cover obstetrical and gynecological services whether performed by a physician or a nurse midwife. §500.3406r

State

Contact

Office of Financial and Insurance Services

Regulations

Michigan Compiled Laws, Chapter 500, The Insurance Code of 1956, Act 218 of 1956,

Chapter 34 Disability Insurance Policies

§500.3406a

§500.3406d

§500.3406m

§500.3406r

Chapter 36 Group and Blanket Disability Insurance

§500.3613

§500.3616

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)