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[Billing Codes: 4120-01-P; 4830-01-P; 4510-29-P] - page 40 / 83





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admission and uses whatever hospital the plan may designate.

(ii) In this Example 2, the plan does not violate the rules of this paragraph (c)(3) because the level of benefits provided (70 percent or 80 percent) is consistent throughout the 48-hour (or 96-hour) hospital length of stay required under paragraph (a) of this section. (In addition, the plan does not violate the rules in paragraph (a)(4) or (b)(2) of this section.)

(4) Compensation of attending provider. This section does not prevent a group health

plan from negotiating with an attending provider the level and type of compensation for care

furnished in accordance with this section (including paragraph (b) of this section).

(d) Notice requirement. See 29 CFR 2520.102-3(u) and (v)(2) for rules relating to a

notice requirement imposed under section 711 of the Employee Retirement Income Security Act

of 1974 (29 U.S.C. 1181) on certain group health plans that provide benefits for hospital lengths

of stay in connection with childbirth.

(e) Applicability in certain States — (1) Health insurance coverage. The requirements of

section 9811 and this section do not apply with respect to health insurance coverage offered in

connection with a group health plan if there is a State law regulating the coverage that meets any

of the following criteria:

(i) The State law requires the coverage to provide for at least a 48-hour hospital length of

stay following a vaginal delivery and at least a 96-hour hospital length of stay following a delivery

by cesarean section.

(ii) The State law requires the coverage to provide for maternity and pediatric care in

accordance with guidelines established by the American College of Obstetricians and

Gynecologists, the American Academy of Pediatrics, or any other established professional medical



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