['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:
- If the plan covers surgical services, it must cover mammograms as follows: A baseline mammogram for women 35 to 40 years of age; a mammogram every two years, or more frequently based on the recommendation of the woman's physician, for women 40 to 50 years of age; and a mammogram every year for women 50 years of age and over. (§56-7-2502)
- If the plan covers mastectomies, it must cover all stages of reconstructive breast surgery on the diseased breast as a result of a mastectomy, but not including a lumpectomy, as well as any surgical procedure on the nondiseased breast deemed necessary to establish symmetry between the two breasts in the manner chosen by the patient and physician. (§56-7-2507)
- Plans must offer optional coverage for annual chlamydia screening tests in conjunction with an annual pap smear for covered females who are not more than 29 years of age if the screening test is determined to be medically necessary. (§56-7-2606)
State
Contact
Tennessee Department of Commerce and Insurance
Regulations
Tennessee Code, Title 56, Chapter 7, Part 23 Mandated Insurers or Plan Coverage
http://www.lexisnexis.com/hottopics/tncode/
Tennessee Code, Title 56, Chapter 7, Part 25 - §§56-7-2502, 56-7-2507, 56-7-2606
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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