['Employee Benefits']
["Women's Health Rights and Cancer Act"]
06/13/2024
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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:
- A mammogram every five years for women 35 through 39 years of old age. Annual mammograms for women 40 years old or older.
- Bone density tests for women 45 years old or older.
- A minimum of 48 hours of inpatient care following a vaginal delivery, for the mother and newborn infant after childbirth; a minimum of 96 hours following a delivery by caesarean section.
- If the plan covers treatment of breast cancer and other breast conditions, it must cover 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.
State
Contact
Regulations
Oklahoma Statutes; Title 36 Insurance:
§36-6060 Mammography screening.
§36-6060.1 Bone density testing.
§36-6060.3 Maternity benefits - Postpartum care.
§36-6060.5 Oklahoma Breast Cancer Patient Protection Act.
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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