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[Billing Codes: 4120-01-P; 4830-01-P; 4510-29-P] - page 73 / 83

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childbirth for a mother or her newborn may not restrict benefits for the stay to less than

(i) 48 hours following a vaginal delivery; or

  • (ii)

    96 hours

    • (2)

      When stay

delivery occurs in

following a delivery by cesarean section.

begins

(i)

Delivery

in

a

hospital.

If

a

hospital,

the

hospital

length

of

stay

for

the the

mother or newborn child begins at the time of delivery (or in case of multiple births, at the time of the last delivery).

(ii) outside a

Delivery hospital,

outside a hospital. the hospital length

If delivery occurs of stay begins at the

time

the

mother

or

newborn

is

admitted

as

a

hospital

inpatient

in

connection with childbirth.

The determination of whether an

admission is in connection with childbirth to be made by the attending provider.

is

a

medical

decision

(3)

Examples.

The rules of paragraphs (a)(1) and (a)(2) of

this section are illustrated by the following examples.

In each

example, the issuer provides benefits for stay in connection with childbirth and is requirements of this section, as follows:

hospital lengths subject to the

of

Example 1.

(i)

A pregnant woman covered under a

issued

in

the

individual

market

goes

into

labor

and

is

policy admitted

to the hospital at 10 p.m. on June 11. vaginal delivery at 6 a.m. on June 12.

She gives birth by

(ii) paragraph

In this Example 1, the 48-hour period described (a)(1)(i) of this section ends at 6 a.m. on June

in 14.

Example 2.

(i)

A woman covered under a policy issued

individual

market

gives

birth

at

home

by

vaginal

delivery.

in the After

the delivery, the woman begins bleeding excessively with the childbirth and is admitted to the hospital of the excessive bleeding at 7 p.m. on October 1.

in connection for treatment

73

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