(ii) In this Example 1, the plan violates the rules of this paragraph (c)(3) because coinsurance for the second 24-hour period of the 48-hour stay is greater than that for the preceding portion of the stay. (In addition, the plan also violates the similar rule in paragraph (b)(2) of this section.)
Example 2. (i) A group health plan generally covers 70 percent of the cost of a hospital length of stay in connection with childbirth. However, the plan will cover 80 percent of the cost of the stay if the participant or beneficiary notifies the plan of the pregnancy in advance of 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 or a health insurance issuer offering group health insurance coverage 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) (relating to the disclosure
requirement under section 711(d) of the Act).
(e) Applicability in certain States — (1) Health insurance coverage. The requirements of
section 711 of the Act 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