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[Billing Codes: 4120-01-P; 4830-01-P; 4510-29-P] - page 61 / 83

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illustrated by the following example:

Example.

(i)

A pregnant woman covered under a group health

plan subject to the requirements of this section goes into labor

and is admitted to a hospital.

section.

On

the

third

day

after

She gives birth by

the

delivery,

the

cesarean attending

provider for the mother consults with the mother, and the attending provider for the newborn consults with the mother

regarding the newborn. early discharge of both

The the

attending providers authorize

mother

and

the

newborn.

Both

the are

discharged approximately 72 hours after the delivery. pays for the 72-hour hospital stays.

The plan

(ii)

In this Example, the requirements of this paragraph

(a) have newborn.

been satisfied with respect to the mother and the If either is readmitted, the hospital stay for the

readmission is not subject to this section.

(b) Prohibitions

(1) With respect to mothers

(i)

In

general. offering

A group h group heal

(A) continued

Deny a mo eligibili

of

the

plan

solely

(B)

Provide p

ealth plan, and a health insurance issuer th insurance coverage, may not ther or her newborn child eligibility or ty to enroll or renew coverage under the terms to avoid the requirements of this section; or ayments (including payments-in-kind) or

rebates

to a mother

minimum

protections

(ii) Examples illustrated by the group health plan i

.

to encourage her to accept less than available under this section. The rules of this paragraph (b)(1)

following s subject

examples.

In each example,

to

the

requirements

of

this

the

are the section,

as follows: Example 1.

(i)

A group health plan provides benefits for

at least a 48-hour hospital length of stay following a vaginal

delivery.

If a mother and newborn covered under the plan are

discharged within 24 hours after the waive the copayment and deductible.

delivery,

the

plan

will

(ii) deductible

In is

this Example 1, because waiver in the nature of a rebate that

of the copayment the mother would

and not

61

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