['Employee Benefits']
["Women's Health Rights and Cancer Act"]
04/17/2024
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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:
- Plans must provide the same coverage for maternity benefits to unmarried women and minor female dependents that it provides to married women including the wives of employees choosing dependent family coverage. §62A.041
- If the plan provides maternity benefits, it must provide coverage of a minimum of 48 hours of inpatient care following a vaginal delivery and a minimum of 96 hours of inpatient care following a caesarean section for a mother and her newborn. §62A.0411
- Plans must cover reconstructive surgery if the mastectomy is medically necessary as determined by the attending physician. §62A.25(b)
- The plan must not provide an exclusion, reduction, or other limitation as to coverage, deductible, coinsurance or co-payment applicable solely to conditions attributable to diethylstilbestrol or exposure to diethylstilbestrol, unless the covered person has been diagnosed as having diethylstilbestrol-related cancer prior to the date on which coverage for that person begins. §62A.154
- Plans cannot have an exclusion, reduction, or other limitation as to coverage, deductible, coinsurance, or co-payment applicable solely to conditions caused by breast implants. §62A.285
- Plans must cover routine screening procedures for cancer, including mammograms, surveillance tests for ovarian cancer for women who are at risk for ovarian cancer, and pap smears, when ordered or provided by a physician. §62A.30
- Plans cannot be terminated, canceled, nonrenewed, or contain any increased premium rate, or exclusion, reduction, or limitation on benefits, nor shall coverage be denied, solely because the covered person has been diagnosed as having a fibrocystic breast condition. §62A.305
- Female enrollees are allowed direct access to obstetricians and gynecologists. §62Q.52
State
Contact
Office of Financial and Insurance Services
Regulations
Minnesota Statutes, Chapter 62A Accident and Health Insurance;
§62A.041 Maternity Benefits
§62A.0411 Maternity Care
§62A.285 Prohibited Underwriting; Breast Implants
§62A.25(b) Reconstructive Surgery
§62A.30 Coverage for Diagnostic Procedures for Cancer
§62A.154 Benefits for Des Related Conditions
§62A.305 Fibrocystic Condition; Termination or Reduction of Coverage
Minnesota Statutes, Chapter 62Q; Requirements for health plan companies
§62Q.52 Direct Access to Obstetric and Gynecologic Services
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)
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