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[Billing Codes: 4120-01-P; 4830-01-P; 4510-29-P] - page 53 / 83

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  • (e)

    (1) of this section.

    • (4)

      Examples. The rules of this paragraph (e) are illustrated by the following examples: Example 1. (i) A group health plan buys group health insurance coverage in a State that

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 711 of the Act 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 711 of the Act and this section.

(f) Effective date. Section 711 of the Act applies to group health plans, and health

insurance issuers offering group health insurance coverage, for plan years beginning on or after

January 1, 1998. This section applies to group health plans, and health insurance issuers offering

group health insurance coverage, for plan years beginning on or after January 1, 1999.

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