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[Billing Codes: 4120-01-P; 4830-01-P; 4510-29-P] - page 66 / 83

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Under federal law, group health plans and health insurance

issuers offering group health insurance coverage generally may

not restrict benefits for any hospital length of stay in

connection with childbirth for the mother or newborn child to

less than 48 hours following a vaginal delivery, or less than 96

hours

following

a

delivery

by

cesarean

section.

However,

the

plan or issuer may pay for a shorter stay if the attending

provider (e.g.,your physician, nurse midwife, or physician

assistant), after consultation with the mother, discharges the

mother or newborn earlier.

Also, under federal law, plans and issuers may not set the

level of benefits or out-of-pocket costs so that any later

portion of the 48-hour (or 96-hour) stay is treated in a manner

less

favorable

to

the

mother

or

newborn

than

any

earlier

portion

of the stay.

In addition, a plan or issuer may not, under federal law,

require that a physician or other health care provider obtain

authorization for prescribing a length of stay of up to 48 hours

(or

96

hours).

However,

to

use

certain

providers

or

facilities,

or to reduce your out-of-pocket costs, you may be required to

obtain

precertification.

For

information

on

precertification,

contact your plan administrator.

(3) Timing of paragraph (d)(2) of participant covered

disclosure. this section

under

a

group

The disclosure notice shall be furnished to

health

plan,

and

each

in each

66

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