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[Billing Codes: 4120-01-P; 4830-01-P; 4510-29-P] - page 64 / 83

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(2) Hospital stay benefits not mandated. This section does not apply to any group health plan, or any group health insurance coverage, that does not provide benefits for hospital lengths of stay in connection with childbirth for a mother or her newborn

child. (3) Cost-sharing rules

(i) In general.

This section does

not prevent a group health plan or a health insurance issuer offering group health insurance coverage from imposing deductibles, coinsurance, or other cost-sharing in relation to benefits for hospital lengths of stay in connection with childbirth for a mother or a newborn under the plan or coverage, except that the coinsurance or other cost-sharing for any portion of the hospital length of stay required under paragraph (a) of this section may not be greater than that for any preceding

portion of (ii)

the stay. Examples.

The rules of this paragraph (c)(3) are

illustrated by the following group health plan is subject

examples.

In each example,

to

the

requirements

of

this

the section,

as follows: Example 1.

(i)

A group health plan provides benefits for

at least a vaginal de the stay f of the sta paid by th 24 hours.

48-hour hospital length of stay in connection with

liveries.

The plan covers 80 percent of the cost

or

the

first

24-hour

period

and

50

percent

of

the

of cost

y

for the

e

patient

second 24-hour increases from

period.

Thus, the coinsurance

20

percent

to

50

percent

after

portion of

the stay. (In

similar ru

le in paragraph

(ii) paragraph period of

In this Example 1, the plan violates the rules of this (c)(3) because coinsurance for the second 24-hour the 48-hour stay is greater than that for the preceding

the

addition, (b)(2) of

the plan also violates this section.)

64

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