Women's Health Rights and Cancer Act - Utah

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 provides maternity benefits, the policy may not be limited to a less than a 48-hour benefit for both mother and newborn with a normal vaginal delivery, or less than 96-hour benefit for both mother and newborn with a caesarean section delivery. (§31A-22-610.2)
• If the plan requires an insured to select a primary care physician to receive optimum coverage, it must permit an insured to select a participating provider who is an obstetrician, gynecologist, or pediatrician. (§31A-22-624)
• If the plan covers medical and surgical benefits with respect to a mastectomy, it must cover, with consultation of the attending physician and the patient, reconstruction of the breast on which the mastectomy has been performed; surgery and reconstruction of the breast on which the mastectomy was not performed to produce symmetrical appearance; and prostheses and physical complications with regards to all stages of mastectomy, including lymphedemas. (§31A-22-630)
• The plan may not deny a person's eligibility or continued eligibility to enroll or renew coverage solely for the purpose of avoiding the requirements of Section 31A-22-630. (§31A-22-719)
• The plan may not penalize or otherwise reduce or limit the reimbursement of an attending provider; or provide incentives to an attending provider whether or not the incentives are monetary, to induce a provider to provide care to an insured in a manner inconsistent with this section or Section 31A-22-630. (§31A-22-719)

State

Contact

Utah Insurance Department

Regulations

Utah Code, Title 31A Insurance Code, Chapter 22 Contracts in Specific Lines, §31A-22-610.2 Maternity stay minimum limits

Utah Code, Title 31A Insurance Code, Chapter 22 Contracts in Specific Lines, §31A-22-624 Primary care physician

Utah Code, Title 31A Insurance Code, Chapter 22 Contracts in Specific Lines, §31A-22-630 Mastectomy coverage

Utah Code, Title 31A Insurance Code, Chapter 22 Contracts in Specific Lines, §31A-22-719 Mastectomy coverage

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)