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[Billing Codes: 4120-01-P; 4830-01-P; 4510-29-P] - page 59 / 83

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this section are illustrated by the following examples.

In each

example, the group health plan provides benefits for lengths of stay in connection with childbirth and is the requirements of this section, as follows:

hospital subject to

Example 1. health plan goes p.m. on June 11. on June 12.

(i) into She

A pregnant woman covered under a group labor and is admitted to the hospital at 10 gives birth by vaginal delivery at 6 a.m.

(ii) paragraph

In this Example 1, the 48-hour period described (a)(1)(i) of this section ends at 6 a.m. on June

in 14.

Example 2. (i) gives birth at home

A by

woman covered under a group health plan

vaginal

delivery.

After

the

delivery,

the

woman begins bleeding excessively in connection with the childbirth and is admitted to the hospital for treatment excessive bleeding at 7 p.m. on October 1.

of

the

(ii) paragraph

In this Example 2, the 48-hour period described in (a)(1)(i) of this section ends at 7 p.m. on October

3.

Example 3.

(i)

A woman covered under a group

gives birth by vaginal delivery at develops pneumonia and is admitted attending provider determines that connection with childbirth.

home.

The child

to the

hospital.

the

admission

is

health later The not in

plan

(ii)

In this Example 3, the hospital length-of-stay

requirements admission to

of this section do not apply to the child’s the hospital because the admission is not in

connection with childbirth. (4) Authorization not required

(i)

In general.

A plan

or issuer may not require that a physician or other health care

provider obtain authorization from the plan or issuer for

prescribing the hospital length of stay required under paragraph

(a)(1) of this section.

(See also paragraphs (b)(2) and

(c)(3)

of this section for rules authorization and certain

and examples regarding notice requirements.)

other

(ii)

Example.

The

rule

of

this

paragraph

(a)(4)

is

59

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