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The Newborns’ and Mothers’ Health Protection Act (Newborns’ Act) and its regulations provide that health plans and insurance issuers may not restrict a mother’s or newborn’s benefits for a hospital length of stay that is connected to childbirth to less than 48 hours following a vaginal delivery or 96 hours following a delivery by cesarean section. However, the attending provider (who may be a physician or nurse midwife) may decide, after consulting with the mother, to discharge the mother or newborn child earlier.
A mother cannot be encouraged to accept less than the minimum protections available to her under the Newborns’ Act and an attending provider cannot be induced to discharge a mother or newborn earlier than 48 or 96 hours after delivery.
If delivery occurs in the hospital, the 48-hour period (or 96-hour period) starts at the time of delivery. If delivery occurs outside the hospital and the woman is later admitted to the hospital in connection with childbirth (as determined by the attending provider), the period begins at the time of the admission.
Type of coverage determines applicable law
The type of coverage provided by the plan (insured or self-insured) and state law will determine whether the Newborns’ Act applies to a mother’s or newborn’s coverage.
Summary plan description
All group health plans that provide maternity or newborn infant coverage must include the following statement in their summary plan description (SPD) advising individuals of the Newborns’ Act requirements:
Plans subject to state law requirements will need to prepare SPD statements describing any applicable state law.
Deductibles and cost sharing
Under the Newborns’ Act, group health plans, insurance companies, or health maintenance organizations (HMOs) may impose deductibles or other cost-sharing provisions for hospital stays in connection with childbirth. This is true only if the deductible, coinsurance, or other cost-sharing for the later part of a 48-hour (or 96-hour) stay is not greater than that imposed for the earlier part of the stay.
The Newborns’ and Mothers’ Health Protection Act (Newborns’ Act) and its regulations provide that health plans and insurance issuers may not restrict a mother’s or newborn’s benefits for a hospital length of stay that is connected to childbirth to less than 48 hours following a vaginal delivery or 96 hours following a delivery by cesarean section. However, the attending provider (who may be a physician or nurse midwife) may decide, after consulting with the mother, to discharge the mother or newborn child earlier.
A mother cannot be encouraged to accept less than the minimum protections available to her under the Newborns’ Act and an attending provider cannot be induced to discharge a mother or newborn earlier than 48 or 96 hours after delivery.
If delivery occurs in the hospital, the 48-hour period (or 96-hour period) starts at the time of delivery. If delivery occurs outside the hospital and the woman is later admitted to the hospital in connection with childbirth (as determined by the attending provider), the period begins at the time of the admission.
Type of coverage determines applicable law
The type of coverage provided by the plan (insured or self-insured) and state law will determine whether the Newborns’ Act applies to a mother’s or newborn’s coverage.
Summary plan description
All group health plans that provide maternity or newborn infant coverage must include the following statement in their summary plan description (SPD) advising individuals of the Newborns’ Act requirements:
Plans subject to state law requirements will need to prepare SPD statements describing any applicable state law.
Deductibles and cost sharing
Under the Newborns’ Act, group health plans, insurance companies, or health maintenance organizations (HMOs) may impose deductibles or other cost-sharing provisions for hospital stays in connection with childbirth. This is true only if the deductible, coinsurance, or other cost-sharing for the later part of a 48-hour (or 96-hour) stay is not greater than that imposed for the earlier part of the stay.