Women's Health Rights and Cancer Act - Washington

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 hospital or medical expenses, it must cover screening or diagnostic mammography services on the recommendation of the physician. (§48.21.225)
• If the plan covers hospital or medical care, it must cover reconstructive breast surgery resulting from a mastectomy that resulted from disease, illness, or injury. (§48.21.230)
• The plan cannot deny coverage solely because of a mastectomy or lumpectomy more than five years previously. (§48.21.235)
• The plan must allow female patients to have direct access to timely and appropriate covered women's health care services from the type of health care practitioner of their choice. (§48.42.100)

State

Contact

Office of the Insurance Commissioner

Regulations

Revised Code of Washington

Title 48 Insurance

Chapter 48.21 RCW Group and Blanket Disability Insurance

§48.21.225 Mammograms - Insurance coverage

§48.21.230 Reconstructive breast surgery.

§48.21.235 Mastectomy, lumpectomy

§48.42.100 Women's health care services - Duties of health care carriers

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)