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[Billing Codes: 4120-01-P; 4830-01-P; 4510-29-P] - page 42 / 83

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requires that the coverage 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) In this Example 1, the coverage is subject to State law, and the requirements of section 9811 and this section do not apply.

Example 2. (i) A self-insured group health plan covers hospital lengths of stay in connection with childbirth in a State that requires health insurance coverage to provide for maternity care in accordance with guidelines established by the American College of Obstetricians and Gynecologists and to provide for pediatric care in accordance with guidelines established by the American Academy of Pediatrics.

  • (ii)

    In this Example 2, even though the State law satisfies the criterion of paragraph

    • (e)

      (1)(ii) of this section, because the plan provides benefits for hospital lengths of stay in

connection with childbirth other than through health insurance coverage, the plan is subject to the requirements of section 9811 and this section.

(f) Effective date. Section 9811 applies to group health plans for plan years beginning on

or after January 1, 1998. This section applies to group health plans for plan years beginning on or

after January 1, 1999.

Par. 5. In §54.9831-1T, paragraph (b)(1) is revised to read as follows:

§54.9831-1T Special rules relating to group health plans (temporary).

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  • (b)

    Excepted benefits--(1) In general. The requirements of §§54.9801-1T through

    • 54.9801

      -6T, 54.9802-1T, 54.9811-1T, and 54.9812-1T do not apply to any group health plan in

relation to its provision of the benefits described in paragraph (b)(2), (3), (4), or (5) of this section

(or any combination of these benefits).

*****

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