Women's Health Rights and Cancer Act - Oregon

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 or reimbursement for mastectomy-related services as determined by the attending physician and enrollee to be part of the participant’s course or plan of treatment.
• Coverage for expenses associated with pregnancy care.
• Coverage for mammograms for the purpose of diagnosis in symptomatic or high-risk women at any time upon referral of the woman’s health care provider; and annual mammograms for the purpose of early detection for a woman 40 years of age or older, with or without referral from the woman’s health care provider; more often if the woman is determined by her health care provider to be at high risk for breast cancer.
• Coverage for annual pelvic examinations and Pap smear annually for women 18 to 64 years of age, and at any time upon referral of the woman’s health care provider.
• If the plan requires an enrollee to designate a participating primary care provider, it must permit a female enrollee to designate a women’s health care provider as the enrollee’s primary care provider.

State

Contact

Oregon Insurance Division

Regulations

Oregon Revised Statutes

Chapter 743 Health and Life Insurance

https://www.oregonlegislature.gov/bills_laws/ors/ors743.html

§743.691, 743.693, 743.727, 743.728, 743.845.

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)