['Employee Benefits']
["Women's Health Rights and Cancer Act"]
04/15/2024
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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 providing maternity coverage must also provide, where necessary to protect the life of the infant or mother, coverage for transportation, including air transport, for the medically high-risk pregnant woman with an impending delivery of a potentially viable infant to the nearest available tertiary care facility.
- Coverage for low-dose screening mammograms; one baseline mammogram to persons 35 through 39 years old, one mammogram biennially to persons 40 through 49 years old, and one mammogram annually to persons 50 years and over. Coverage shall be available only for screening mammograms obtained on equipment designed specifically to perform low-dose mammography in imaging facilities that have met American college of radiology accreditation standards for mammography.
- Coverage for not less than 48 hours of inpatient care following a mastectomy and not less than 24 hours of inpatient care following a lymph node dissection for the treatment of breast cancer.
- Coverage for cytologic (Pap) screening for determining the presence of precancerous or cancerous conditions and other health problems. The coverage shall make available cytologic screening, as determined by the health care provider in accordance with national medical standards, for women who are 18 years of age or older and for women who are at risk of cancer or at risk of other health conditions that can be identified through cytologic screening.
- If the plan provides a prescription drug benefit, it must cover prescription contraceptive drugs or devices approved by the food and drug administration.
- Coverage for an alpha-fetoprotein IV screening test for pregnant women, generally between 16 and 20 weeks of pregnancy, to screen for certain genetic abnormalities in the fetus.
State
Contact
Regulations
New Mexico Statutes, Chapter 59A
- §59A-22-35 Maternity transport
- §59A-22-39 Mammograms
- §59A-22-39.1 Mastectomies — hospital stay
- §59A-22-40 Pap tests
- §59A-22-42 Contraceptive drugs/devices
- §59A-22-45 Alpha-fetoprotein IV screening
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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