receive if she and prohibited by this violates paragraph
her newborn remained in the hospital, it is
paragraph (b)(2) of
(b)(1). (In this section
addition, the plan because, in effect,
copayment or deductible is required for the first portion stay and a double copayment and a deductible are required second portion of the stay.)
of the for the
A group health plan provides benefits for
at least a delivery.
48-hour hospital length of In the event that a mother
stay following a vaginal and her newborn are
discharged earlier than 48 hours and the discharges consultation with the mother in accordance with the
occur after requirements
of paragraph (a)(5) of this section, follow-up visit by a nurse within 48 to provide certain services that the otherwise receive in the hospital.
the plan provides for a hours after the discharges mother and her newborn would
In this Example 2, because the follow-up visit does
not provide any services beyond what the mother would receive in the hospital, coverage for the
and her newborn follow-up visit
not prohibited by this
paragraph (b)(1). benefit restrictions
Subject to paragraph (c)(3) of this section, a group
health plan, and a health insurance issuer offering group insurance coverage, may not restrict the benefits for any
of a hospital length of stay required under paragraph (a) of section in a manner that is less favorable than the benefits provided for any preceding portion of the stay.
(ii) Example. illustrated by the
The rules of this following example:
A group health plan subject to
lengths of stay in connection delivery by cesarean section,
In the case of a
first 48 hours.
With respect to each succeeding 24-hour period,
the participant or beneficiary must call the plan to obtain
precertification from an additional 24-hour
a utilization reviewer, who determines if
approval is not obtained, the plan any succeeding 24-hour period.
In this Example, the requirement to obtain