Women's Health Rights and Cancer Act - Montana

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 cover one baseline mammogram for women 35 to 40 years old, a mammogram every two years for women 40 to 50 years old (or more frequently if recommended by the woman's physician), and annual mammograms for women 50 years old or older. §33-22-132
• If the plan covers maternity services, it must provide coverage for at least 48 hours of inpatient hospital care following a vaginal delivery and at least 96 hours of inpatient hospital care following delivery by cesarean section. §33-22-133
• Plans must provide cover hospital inpatient care for a period of time as is determined by the attending physician and, in the case of a health maintenance organization, also the primary care physician, in consultation with the patient, to be medically necessary following a mastectomy, a lumpectomy, or a lymph node dissection for the treatment of breast cancer. §33-22-134
• Plans must cover reconstructive breast surgery resulting from a mastectomy that resulted from breast cancer. §33-22-135
• If the plan provides for primary care or obstetrical or gynecological care, it must allow obstetricians and gynecologists to participate as primary care physicians. §33-22-1903
• If a plan participant has not selected a participating obstetrician or gynecologist as the participant’s primary care physician, the plan must allow self-referral to any participating obstetrician or gynecologist. §33-22-1904

State

Contact

State Auditor’s Office, Division of Insurance

Regulations

Montana Code Annotated;
Title 33 - Insurance and Insurance Companies, Chapter 22 - Disability Insurance, Part 1 - General provisions.

§33-22-132 http://leg.mt.gov/bills/mca/33/22/33-22-132.htm

§33-22-133 http://leg.mt.gov/bills/mca/33/22/33-22-133.htm

§33-22-134 http://leg.mt.gov/bills/mca/33/22/33-22-134.htm

§33-22-135 http://leg.mt.gov/bills/mca/33/22/33-22-135.htm

§33-22-1903 http://leg.mt.gov/bills/mca/33/22/33-22-1903.htm

§33-22-1904 http://leg.mt.gov/bills/mca/33/22/33-22-1904.htm

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)