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[Billing Codes: 4120-01-P; 4830-01-P; 4510-29-P] - page 11 / 83

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NMHPA and the interim rules (whether or not a specific attending provider is actually induced to

furnish care inconsistent with NMHPA and the interim rules).

Construction

NMHPA and the interim rules apply only to group health plans and health insurance

issuers that provide benefits for a hospital stay in connection with childbirth. NMHPA and the

interim rules do not require plans and issuers to provide these benefits.5 In addition, NMHPA and

the interim rules do not prevent plans or issuers from imposing deductibles, coinsurance, or other

cost-sharing measures for health benefits relating to hospital stays in connection with childbirth as

long as the cost-sharing for any portion of a hospital stay subject to the general rule is not less

favorable to mothers and newborns than that imposed on any preceding portion of the stay. Thus,

for example, with respect to a 48-hour hospital stay, the coinsurance for the second 24 hours

cannot be greater than that for the first 24 hours.

With respect to health insurance coverage offered in the individual market, NMHPA and

the interim rules apply to all health insurance coverage, and are not limited in their application to

5 While NMHPA and the interim rules do not require plans and issuers to provide coverage for hospital stays in connection with childbirth, other legal requirements may apply, including Title VII of the Civil Rights Act of 1964 (Title VII). Title VII prohibits discrimination on the basis of sex, including because of pregnancy, childbirth, or related medical conditions. 42 U.S.C. 2000e-(k). The Equal Employment Opportunity Commission (EEOC) has commented, by letter dated July 28, 1997, that, “[u]nder Title VII, women affected by pregnancy, childbirth, or related medical conditions must be treated the same as individuals affected by other medical conditions. This applies to all aspects of employment, including employer-provided health insurance benefits. . . . Thus, Title VII prohibits a plan from excluding hospital stay benefits in connection with childbirth if the plan provides hospital stay benefits in connection with other medical conditions.” EEOC is the federal agency responsible for enforcing Title VII and other federal equal employment opportunity laws. Questions regarding Title VII should be directed to the EEOC.

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