illustrated by the following examples.
In each example, the
issuer is follows:
Example 1. 48-hour hospital
An issuer provides benefits for at least a
of stay in connection with vaginal covers 80 percent of the cost of the
for the first 24-hour period and 50 percent of stay for the second 24-hour period. Thus, the by the patient increases from 20 percent to 50
the cost of the coinsurance paid percent after 24
In this Example 1, the issuer violates the rules of
this paragraph (c)(3) because coinsurance for the second 24-hour
period of the 48-hour stay is greater than that for
of the stay.
addition, (b)(2) of
the issuer also this section.)
the preceding violates the
An issuer generally covers 70 percent of
the cost of childbirth.
a hospital length of However, the issuer
in connection with cover 80 percent of
cost of the stay if the covered individual notifies the the pregnancy in advance of admission and uses whatever the issuer may designate.
issuer of hospital
In this Example 2, the issuer does not violate the
rules of this paragraph (c)(3) because the level of benefits provided (70 percent or 80 percent) is consistent throughout 48-hour (or 96-hour) hospital length of stay required under
paragraph (a) of this section. violate the rules in paragraph section.)
(In addition, the issuer does not (a)(4) or paragraph (b)(2) of this
(4) Compensation of attending provider. This section does not prevent an issuer from negotiating with an attending provider the level and type of compensation for care furnished in accordance with this section (including paragraph (b) of this section).
This section applies to all health
limited in its application to coverage that is provided to eligible individuals as defined in section 2741(b) of the PHS