Women's Health Rights and Cancer Act - New York

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:

• Inpatient hospital coverage for mother and newborn for at least 48 hours after childbirth for any delivery other than a caesarean section, and for at least 96 hours after a caesarean section.
• Maternity care coverage shall also include, at minimum, parent education, assistance and training in breast or bottle feeding, and the performance of any necessary maternal and newborn clinical assessments.
• Plans may not exclude coverage for hospital care for diagnosis and treatment of correctable medical conditions otherwise covered by the policy solely  because  the  medical condition results in infertility.
• Coverage for lymph node dissection or a lumpectomy for the treatment of breast cancer or a mastectomy covered by the policy.
• Coverage for all stages of reconstruction of the breast on which a mastectomy has been performed; and surgery and reconstruction of the other breast to produce a symmetrical appearance.
• A single baseline mammogram for covered persons 35 through 39 years old and annual mammograms for covered persons 40 years old and older.
• Coverage for annual cervical  cytology screenings (Pap) for cervical cancer and its precursor states for women aged 18 and older.

State

Contact

New York Department of Insurance

Regulations

Consolidated Laws of New York; Insurance
Article 32 Insurance Contracts - Life, Accident and Health, Annuities

§3221 Group or blanket accident and health insurance policies; standard provisions
Paragraph (k)(5) Maternity care

Paragraph (k)(6) Infertility

Paragraph (k)(8) Lymph node dissection/lumpectomy

Paragraph (k)(10) Breast reconstruction following mastectomy

Paragraph (l)(11) Mammograms

Paragraph (l)(14) Pap smears

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)