Women's Health Rights and Cancer Act - New Hampshire

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:

• Coverage mammograms for all women 35 or more years old; a baseline mammogram for women 35 to 39 years old, a mammogram every 1 to 2 years for women 40 to 49 years old, and an annual mammogram for women 50 years or older.
• The length of hospital stay and the number of postpartum visits must be determined by the attending health care provider based on clinical information. The length of stay shall not be determined by the health insurer or the hospital based on economic criteria. Any length of hospital stay shorter than the current minimum nationally accepted guidelines for prenatal care must be at the recommendation of the attending health care provider and the mother.
• The insurer shall pay for medically necessary prenatal homemaker services when a woman is confined to bed rest or her activities of daily living are otherwise restricted on the recommendation of her attending health care provider who must consult with the applicable case manager.
• Coverage for reconstruction of the breast on which surgery has been performed and surgery and reconstruction of the other breast to produce a symmetrical appearance if the patient elects reconstruction and in the manner chosen by the patient and the physician.
• Health plans must not require prior authorization by a covered person's primary care provider for coverage for services provided by obstetricians and gynecologists.

State

Contact

New Hampshire Insurance Department

Regulations

New Hampshire Revised Statutes;
Title XXXVII Insurance,
Chapter 417-D Women’s Health Care
Chapter 420-J:6 Obstetrical-Gynecological Coverage

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)