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[Billing Codes: 4120-01-P; 4830-01-P; 4510-29-P] - page 14 / 83





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mother. The interim rules clarify that State laws that require the mother to consent to the

decision made by the attending provider satisfy this criterion.

Although this NMHPA exception applies with respect to insured group health plans, it

does not apply with respect to a group health plan to the extent the plan provides benefits for

hospital lengths of stay in connection with childbirth other than through health insurance


Notice requirements under ERISA and the PHS Act

ERISA background. ERISA generally requires that participants in, and beneficiaries

receiving benefits under, a group health plan be furnished a summary plan description (SPD) to

apprise them of their rights and obligations under the plan. ERISA and its implementing

regulations prescribe what is to be included in the SPD, and the manner in which participants and

beneficiaries are to be notified of any “material modification” to the terms of the plan or any

change in the information required to be included in the SPD. A summary description of a

material modification is generally required to be furnished not later than 210 days after the end of

the plan year in which the change is adopted. A summary of any material reduction in covered

services or benefits is generally required to be furnished not later than 60 days after adoption of

the change.

NMHPA changes to ERISA and the PHS Act. The NMHPA amendments to ERISA

added section 711(d), which requires that the imposition of the NMHPA requirements is to be

8 In conducting an economic analysis of the interim rules, the Departments of Labor and HHS conducted a preliminary review of State laws to determine the applicability of NMHPA’s requirements in each State. This discussion, in section D of this preamble, includes a list of the States in which the Departments of Labor and HHS assumed, solely for the purpose of the economic analysis, that NMHPA’s requirements apply.


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