Women's Health Rights and Cancer Act - Virginia

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 obstetrical or gynecological services, it must permit any female of age thirteen or older direct access to the health care services of a participating obstetrician-gynecologist without prior authorization from the primary care physician. (§38.2-3407.11)
• The plan must offer obstetrical services as an option available in the case of benefits based upon treatment as an inpatient in a general hospital. (§38.2-3414)
• If the plan covers obstetrical services, it must coverage for postpartum services accordance with the medical criteria, outlined in the most current version of or an official update to the "Guidelines for Perinatal Care" prepared by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists or the "Standards for Obstetric-Gynecologic Services" prepared by the American College of Obstetricians and Gynecologists. (§38.2-3414.1)
• The plan must cover low-dose screening mammograms for determining the presence of occult breast cancer. (§38.2-3418.1)
• The plan must cover annual pap smears, including coverage, on and after July 1, 1999, for annual testing performed by any FDA-approved gynecologic cytology screening technologies. (§38.2-3418.1:2)
• The plan must cover reconstructive breast surgery, including surgery performed coincident with or following a mastectomy or following a mastectomy to reestablish symmetry between the two breasts, and prostheses, determined as necessary in consultation with the attending physician and patient, and physical complications of mastectomy, including medically necessary treatment of lymphedemas. (§38.2-3418.4)
• The plan must cover a minimum stay in the hospital of not less than 48 hours for a patient following a radical or modified radical mastectomy and not less than 24 hours of inpatient care following a total mastectomy or a partial mastectomy with lymph node dissection for the treatment of breast cancer. (§38.2-3418.6)
• The plan must cover coverage laparoscopy-assisted vaginal hysterectomy and vaginal hysterectomy. Such coverage must include benefits for a minimum stay in the hospital of not less than 23 hours for a laparoscopy-assisted vaginal hysterectomy and 48 hours for a vaginal hysterectomy. (§38.2-3418.9)
• The plan must cover lymphedema, including equipment, supplies, complex decongestive therapy, and outpatient self-management training and education for the treatment of lymphedema, if prescribed by a health care professional. (§38.2-3418.14)

State

Contact

Bureau of Insurance

Regulations

Code of Virginia

Title 38.2 Insurance

Chapter 34 - Provisions Relating to Accident and Sickness Insurance

§38.2-3407.11

§38.2-3414

§38.2-3414.1

§38.2-3418.1

§38.2-3418.1:2

§38.2-3418.4

§38.2-3418.6

§38.2-3418.9

§38.2-3418.14

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)