A group health plan generally
covers 70 connection
childbirth. of the stay
However, the plan if the participant
plan of the pregnancy hospital the plan may
in advance designate.
will cover 80 percent of the or beneficiary notifies the admission and uses whatever
In this Example 2, the plan does not violate the rules
of this paragraph (70 percent or 80
(c)(3) because the level of benefits provided percent) is consistent throughout the 48-hour
(or 96-hour) hospital
length of addition,
stay required the plan does
under paragraph (a) not violate the of this section.)
(4) Compensation of attending provider. This section does not prevent a group health plan or a health insurance issuer offering group health insurance coverage from negotiating with an attending provider the level and type of compensation for care
furnished in accordance with
of this section).
this section (including paragraph
Except as provided in paragraph
(d)(4)of this section, a group health plan that provides benefits for hospital lengths of stay in connection with childbirth must meet the following requirements:
(1) Required statement.
The plan document that provides a
description of plan benefits to participants and beneficiaries must disclose information that notifies participants and beneficiaries of their rights under this section.
(2) Disclosure notice.
To meet the disclosure requirement
set forth in paragraph disclosure notice must
(d)(1) of be used:
Statement of Rights under the Newborns’ and Mothers’ Health