['Employee Benefits']
["Women's Health Rights and Cancer Act"]
07/17/2024
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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:
- For females 50 years or older, coverage must be provided for an annual mammogram screening. For females less than 50 years of age, coverage for screening must be provided upon recommendation of a health care provider. (§4100a)
- Plans must cover outpatient contraceptive services including sterilizations, and (if the plan covers prescription drugs) provide coverage for the purchase of all prescription contraceptives and prescription contraceptive devices approved by the federal Food and Drug Administration. (§4099c)
State
Contact
Department of Banking, Insurance, Securities, and Health Care Administration
Regulations
Vermont State Statutes; Title 8 Banking and Insurance
Chapter 107: Health Insurance
Mammograms - §4100a
Contraceptives - §4099c
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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Copyright 2024 J. J. Keller & Associate, Inc. For re-use options please contact copyright@jjkeller.com or call 800-558-5011.