Women's Health Rights and Cancer Act - South Carolina

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 coverage for the hospitalization for mastectomies must provide benefits for hospitalization for at least 48 hours following a mastectomy. Attending physician may release the patient prior to the expiration of the time provided herein. In the case of an early release, coverage shall include at least one home care visit if ordered by the attending physician. (§38-71-125)
• Plans providing coverage for mastectomy surgery must provide coverage for prosthetic devices and reconstruction of the breast on which surgery for breast cancer has been performed and surgery and reconstruction of the non-diseased breast, if determined medically necessary by the patient's attending physician with the approval of the insurer or HMO. (§38-71-130)
• Plans providing coverage for the hospitalization and attendant professional services of a mother and her newborn child or children must provide for the mother and her newborn child or children to remain in the hospital for at least 48 hours after a vaginal delivery, not including the day of delivery, and at least 96 hours following a Cesarean Section, not including the day of surgery. (§38-71-135)
• Plans must include coverage in the policy for mammograms and annual pap smears. As for mammograms, this includes once as a base-line mammogram for a female who is between 35 and 40 years old; once every two years for a female who is between 40 and 50 years old; once a year for a female who is at least fifty years of age; or in accordance with the most recent published guidelines of the American Cancer Society. Pap smears are to be made once a year or more often if recommended by a medical doctor. (§38-71-145)

State

Contact

South Carolina Department of Insurance

Regulations

South Carolina Code

Title 38 Insurance

Chapter 71 Accident and Health Insurance

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)