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[Billing Codes: 4120-01-P; 4830-01-P; 4510-29-P] - page 76 / 83

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(A) continued avoid the

Deny a mother or her newborn child eligibility or eligibility to enroll in or renew coverage solely requirements of this section; or

(B)

Provide payments (including payments-in-kind) or

general.

An

issuer

may

not

the

are the

than

issuer

is

subject

to

the

requirements

of

this

section,

as

to encourage her to accept less available under this section.

paragraph (b)(1) In each example,

rebates

to a mother

minimum

protections

The rules of this

illustrated

by

the

following

examples.

(ii)

Examples.

to

follows: Example 1.

(i)

An issuer provides benefits for at least a

48-hour hospital length of stay following a vaginal delivery. a mother and newborn covered under a policy issued in the individual market are discharged within 24 hours after the delivery, the issuer will waive the copayment and deductible.

If

(ii) deductible

In is

this Example 1, because waiver in the nature of a rebate that

of the copayment the mother would

and not

receive if she and prohibited by this violates paragraph

her newborn remained in the hospital, it is

paragraph

(b)(1). (In

addition,

the issuer

(b)(2) of

this section

because,

in effect,

no

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

Example 2. 48-hour hospital the event that a

(i) An issuer length of stay mother and her

provides benefits for at least following a vaginal delivery. newborn are discharged earlier

a In

than

48

hours

and

the

discharges

occur

after

consultation

with

the mother in accordance with the requirements of (a)(5) of this section, the issuer provides for a

paragraph follow-up

visit

by a nurse within 48 hours after certain services that the mother receive in the hospital.

the and

discharges to provide her newborn would otherwise

(ii)

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 is not prohibited by this paragraph (b)(1).

and her newborn follow-up visit

76

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