Women's Health Rights and Cancer Act - Texas

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:

• The plan must cover an annual screening by low-dose mammography for the presence of occult breast cancer. (§1356.005)
• If the plan covers mastectomies, it must cover reconstruction of the breast on which the mastectomy has been performed, surgery and reconstruction of the other breast to achieve a symmetrical appearance, and prostheses and treatment of physical complications, including lymphedemas, at all stages of mastectomy. (§1357.004)
• If the plan covers the treatment of breast cancer, it must cover inpatient care for a minimum of 48 hours following a mastectomy, and 24 hours following a lymph node dissection for the treatment of breast cancer. (§1357.054)
• An issuer of a group health benefit plan that provides pregnancy-related benefits must offer to each holder or sponsor of the plan, coverage for services and benefits on an expense incurred, service, or prepaid basis for outpatient expenses that arise from in vitro fertilization procedures. (§1366.003)
• If the plan covers diagnostic medical procedures, it must cover, for each woman 18 years of age or older enrolled in the plan, expenses for an annual medically recognized diagnostic examination for the early detection of cervical cancer. This includes at a minimum a conventional Pap smear screening or a screening using
• liquid-based cytology methods, alone or in combination with a test for the detection of the human papillomavirus. The plan must provide notice to covered women 18 years and older, of this benefit in the written plan. (§1370.003, and §1370.004- added by HB1485)
• A health benefit plan issuer that reimburses a physician or health care provider for reproductive health or oncology services provided to women must reimburse the physician or provider in an amount at least equal to the annual average compensation per hour or unit that would be paid in the service area to a physician or provider for the same medical, surgical, hospital, pharmaceutical, nursing, or other similar resources used to provide the services if the resources would be used to provide health services exclusively to men or to the general population. (§1454.051)

State

Contact

Texas Department of Insurance

Regulations

Texas Insurance Code, Title 8 Health Insurance and Other Health Coverages

Chapter 1356 Low-Dose Mammography

Chapter 1357 Mastectomy

Chapter 1366 Benefits Related To Fertility and Childbirth

Chapter 1454 Equal Health Care for Women

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)