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[Billing Codes: 4120-01-P; 4830-01-P; 4510-29-P] - page 50 / 83

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to furnish care to a participant or beneficiary in a manner inconsistent with this section, including

providing any incentive that could induce an attending provider to discharge a mother or newborn

earlier than 48 hours (or 96 hours) after delivery.

  • (c)

    Construction. With respect to this section, the following rules of construction apply:

    • (1)

      Hospital stays not mandatory. This section does not require a mother to —

  • (i)

    Give birth in a hospital; or

  • (ii)

    Stay in the hospital for a fixed period of time following the birth of her child.

    • (2)

      Hospital stay benefits not mandated. This section does not apply to any group health

plan, or any group health insurance coverage, that does not provide benefits for hospital lengths

of stay in connection with childbirth for a mother or her newborn child.

(3) Cost-sharing rules — (i) In general. This section does not prevent a group health

plan or a health insurance issuer offering group health insurance coverage from imposing

deductibles, coinsurance, or other cost-sharing in relation to benefits for hospital lengths of stay in

connection with childbirth for a mother or a newborn under the plan or coverage, except that the

coinsurance or other cost-sharing for any portion of the hospital length of stay required under

paragraph (a) of this section may not be greater than that for any preceding portion of the stay.

(ii) Examples. The rules of this paragraph (c)(3) are illustrated by the following

examples. In each example, the group health plan is subject to the requirements of this section, as

follows:

Example 1. (i) A group health plan provides benefits for at least a 48-hour hospital length of stay in connection with vaginal deliveries. The plan covers 80 percent of the cost of the stay for the first 24-hour period and 50 percent of the cost of the stay for the second 24-hour period. Thus, the coinsurance paid by the patient increases from 20 percent to 50 percent after 24 hours.

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