Women's Health Rights and Cancer Act - Rhode Island

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 must not cover induced abortions, except where the life of the mother would be endangered if the fetus were carried to term or where the pregnancy resulted from rape or incest, and except by an optional rider for which there must be paid an additional premium.
• Like federal requirements, coverage for 48 hours in a hospital after a vaginal birth and 96 hours after a Cesarean section for a mother and her newly born child.
• If the plan covers physician services in a physician's office, it must cover prosthetic devices and/or reconstructive surgery to restore and achieve symmetry for the patient incident to a mastectomy. Reconstructive surgery must be performed within 18 months of the original mastectomy.
• Coverage for a minimum 48 hour hospital stay after mastectomy, and a minimum 24 hour stay after an axilary node dissection.
• Coverage for mammograms and pap smears, in accordance with guidelines established by the American Cancer Society.
• If the plan covers obstetric and gynecological care, it must permit women to receive an annual visit to an in-network obstetrician/gynecologist for routine gynecological care without requiring the women to first obtain a referral from a primary care provider.

State

Contact

Department of Business Regulation, Division of Insurance

Regulations

Rhode Island General Laws; Title 27 Insurance
Chapter 27-18 Accident and Sickness Insurance Policies:

§27-18-28 (Abortion)
http://webserver.rilin.state.ri.us/statutes/title27/27-18/27-18-28.htm

§27-18-33.1 (Postpartum hospital stay)
http://webserver.rilin.state.ri.us/statutes/title27/27-18/27-18-33.1.htm

§27-18-39 (Mastectomy treatment)
http://webserver.rilin.state.ri.us/statutes/title27/27-18/27-18-39.htm

§27-18-40 (Hospital stay after mastectomy)
http://webserver.rilin.state.ri.us/statutes/title27/27-18/27-18-40.htm

§27-18-41 (Mammograms and pap smears)
http://webserver.rilin.state.ri.us/statutes/title27/27-18/27-18-41.htm

§27-18-44 (Primary and preventive Ob/Gyn care)
http://webserver.rilin.state.ri.us/statutes/title27/27-18/27-18-44.htm

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)