Women's Healthcare Protections
Comprehensive health insurance policies sold in New York must include coverage for women’s health care services, including preventive care screenings, cancer screenings and treatment, contraceptives, infertility, maternity care, maternal depression, and medically necessary abortions.
When Women’s Health Care Protections Apply
These protections apply to:
- Individual Health Insurance Coverage that you bought in New York, including through the NY State of Health Marketplace.
- Group Health Insurance Coverage that your employer bought in New York, including through the NY State of Health Marketplace.
- The New York State Health Insurance Program (NYSHIP) for New York State or local government employees.
Similar protections apply to Medicaid, Essential Plan, or Child Health Plus coverage.
If you have Medicaid, Essential Plan, or Child Health Plus, check the New York State Department of Health website for the protections that apply.
These protections do not apply to:
- Out-of-State Coverage. If your employer bought your policy in another state, contact your employer.
- Self-Funded Coverage. If your employer self-funds the coverage (your employer, and not an insurer, pays the claims), contact your employer.
- Medicare. If you have Medicare, check with the Centers for Medicare & Medicaid Services (CMS) at (800) MEDICARE, the Medicare Rights Center at (800) 333-4114, or www.medicare.gov.
Preventive Care Screenings
- Bone Mineral Density. You are covered for bone mineral density measurements and testing without cost-sharing.
- Cervical Cancer Screenings. You are covered for cervical cancer screening without cost-sharing.
- OB/GYN Services. You are covered for an annual well-woman preventive care visit without cost-sharing. You do not have to get a referral for OB/GYN examinations, care resulting from the annual examination, treatment of acute gynecologic conditions, and any care related to a pregnancy.
- Other Preventive Care and Screenings. You are covered for preventive care and screenings that have an A or B rating from the United Services Preventive Services Taskforce (USPSTF) or that are recommended by the Health Resources and Services Administration (HRSA) without cost-sharing (unless you have coverage under a large group grandfathered plan – check with your employer).
- Immunizations. You are covered for immunizations that have a recommendation from the Advisory Committee on Immunization Practices (ACIP) without cost-sharing (unless you have coverage under a large group grandfathered plan – check with your employer).
Breast Cancer Screenings
You are covered for the following breast cancer screenings without cost-sharing:
- One preventive screening mammogram (including 3D mammogram) if you are between the ages of 35 – 39.
- Preventive screening mammograms (including 3D mammogram) once a year if you are 40 or older.
- Preventive screening mammograms (including 3D mammogram) once a year, at any age when recommended by your doctor, if you have a history of breast cancer or a first degree relative with a history of breast cancer.
- Preventive screening mammograms (including 3D mammogram) once a year that are recommended by your doctor and determined to be medically necessary by your health plan if you are ages 35 – 39 and you are covered under a large group policy (employers that have 101 or more employees).
- Diagnostic mammograms, ultrasounds, and MRIs to detect breast cancer.
Breast Cancer Genetic Testing, Preventive Medications, and Treatment
Breast Cancer Genetic Testing. You are covered for genetic counseling and testing, without cost-sharing, if you have a personal or family history of breast, ovarian, tubal, or peritoneal cancer or you have a family history of BRCA1/2 gene mutations.
Breast Cancer Preventive Medications. You are covered for risk-reducing medications, such as tamoxifen, raloxifene, or aromatase inhibitors, without cost-sharing, if you are at increased risk for breast cancer and at low risk for adverse medication effects.
Mastectomy Coverage. You are covered for a mastectomy. After a mastectomy, you have the right to stay in the hospital until you and your doctor decide that it is medically appropriate for you to go home. You may have deductibles, coinsurance or co-payments for these services.
Breast Reconstruction. You are covered for reconstructive surgery after a mastectomy on the breast on which the mastectomy has been performed and on the other breast to produce a symmetrical appearance, as well as for breast prosthetics, and treatment of lymphedemas. You may have deductibles, coinsurance or co-payments for these services.
- Covered Contraceptives. You are covered for contraceptive drugs, devices, and products without cost-sharing, including:
- Emergency contraceptives.
- Over-the-counter contraceptives.
- Voluntary sterilizations.
- Patient education and counseling on contraceptives.
- Follow-up services related to contraceptives, including management of side effects, counseling for continued adherence, and device insertion and removal.
- Drug Formularies. Your health plan does not have to cover all contraceptives so long as each different kind of drug is covered. You can ask your health plan to cover a contraceptive that is not on their formulary. Your health care provider should complete a Contraceptive Exception Request Form and send it to your health insurer.
- Contraceptive Supply. You can get a 12-month supply of contraceptives filled at one time.
- Religious Employers. Certain employers (called “religious employers”) are not required to cover contraceptives, but their employees can buy this coverage directly from their health plan.
- Infertility. You are covered for basic infertility services (for example, tests to determine the cause of infertility and artificial insemination). This includes immediate coverage for basic infertility services (intrauterine insemination procedures) if you are unable to conceive due to your sexual orientation or gender identity. You may have deductibles, coinsurance, or co-payments for these services.
- IVF Coverage – Large Group Coverage. You are covered for three cycles of IVF if you have large group coverage (employers that have 101 or more employees). You may have deductibles, coinsurance, or co-payments for these services.
- Fertility Preservation. You are covered for fertility preservation services if you will be having treatment or surgery that will affect your fertility (for example, chemotherapy or other cancer treatments). You may have deductibles, coinsurance, or co-payments for these services.
For more information on infertility coverage, see our Health Insurance Coverage for Infertility Services, Fertility Preservation Services, and Health Care Services Related to Surrogacy FAQs.
Prenatal Care and Maternity Care
Prenatal Care. You are covered for routine prenatal care, including screenings like gestational diabetes, hepatitis B, HIV, preeclampsia, and Rh blood typing, without cost-sharing.
Maternity Care. You are covered for maternity care. This includes the services of a licensed midwife. You have the right to remain in the hospital for 48 hours after delivery and at least 96 hours after a Caesarean section. If you leave the hospital earlier, you are covered for one home health care visit. You may have deductibles, coinsurance, or co-payments for these services, except that you will not have cost-sharing for the home health visit.
Breast Feeding. You are covered for breastfeeding support, counseling, and supplies, including the rental or purchase of a breast pump, for the entire time you are breastfeeding, without cost-sharing.
Maternal Depression Screening. You are covered for maternal depression screening without cost-sharing.
Surrogacy. Your health plan cannot deny coverage for prenatal care or maternity care benefits if you are acting as a surrogate. If you are a surrogate, you have a right to comprehensive health insurance coverage for up to 12 months after the birth of the child. This coverage is paid for by the intended parents.
Medically Necessary Abortion. You are covered for medically necessary abortion including abortion in cases of rape, incest, or fetal malformation, without cost-sharing. Certain employers (called “religious employers”) are not required to cover medically necessary abortions, but their employees can get this coverage directly from their health plan at no cost.