§ 1185. Standards relating to benefits for mothers and newborns
996 words·~5 min read·
/usc/title-29/section-1185A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
(a)Requirements for minimum hospital stay following birth
(1)In general A group health plan, and a health insurance issuer offering group health insurance coverage, may not—
(A)except as provided in paragraph (2)—
(i)restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child, following a normal vaginal delivery, to less than 48 hours, or
(ii)restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child, following a cesarean section, to less than 96 hours; or
(B)require that a provider obtain authorization from the plan or the issuer for prescribing any length of stay required under subparagraph
(A)(without regard to paragraph (2)).
(2)Exception Paragraph (1)(A) shall not apply in connection with any group health plan or health insurance issuer in any case in which the decision to discharge the mother or her newborn child prior to the expiration of the minimum length of stay otherwise required under paragraph (1)(A) is made by an attending provider in consultation with the mother.
(b)Prohibitions A group health plan, and a health insurance issuer offering group health insurance coverage in connection with a group health plan, may not—
(1)deny to the mother or her newborn child eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the plan, solely for the purpose of avoiding the requirements of this section;
(2)provide monetary payments or rebates to mothers to encourage such mothers to accept less than the minimum protections available under this section;
(3)penalize or otherwise reduce or limit the reimbursement of an attending provider because such provider provided care to an individual participant or beneficiary in accordance with this section;
(4)provide incentives (monetary or otherwise) to an attending provider to induce such provider to provide care to an individual participant or beneficiary in a manner inconsistent with this section; or
(5)subject to subsection (c)(3), restrict benefits for any portion of a period within a hospital length of stay required under subsection
(a)in a manner which is less favorable than the benefits provided for any preceding portion of such stay.
(c)Rules of construction
(1)Nothing in this section shall be construed to require a mother who is a participant or beneficiary—
(A)to give birth in a hospital; or
(B)to stay in the hospital for a fixed period of time following the birth of her child.
(2)This section shall not apply with respect to any group health plan, or any group health insurance coverage offered by a health insurance issuer, which does not provide benefits for hospital lengths of stay in connection with childbirth for a mother or her newborn child.
(3)Nothing in this section shall be construed as preventing a group health plan or issuer from imposing deductibles, coinsurance, or other cost-sharing in relation to benefits for hospital lengths of stay in connection with childbirth for a mother or newborn child under the plan (or under health insurance coverage offered in connection with a group health plan), except that such coinsurance or other cost-sharing for any portion of a period within a hospital length of stay required under subsection
(a)may not be greater than such coinsurance or cost-sharing for any preceding portion of such stay.
(d)Notice under group health plan The imposition of the requirements of this section shall be treated as a material modification in the terms of the plan described in section 1022(a)(1) 1 of this title, for purposes of assuring notice of such requirements under the plan; except that the summary description required to be provided under the last sentence of section 1024(b)(1) of this title with respect to such modification shall be provided by not later than 60 days after the first day of the first plan year in which such requirements apply.
(e)Level and type of reimbursements Nothing in this section shall be construed to prevent a group health plan or a health insurance issuer offering group health insurance coverage from negotiating the level and type of reimbursement with a provider for care provided in accordance with this section.
(f)Preemption; exception for health insurance coverage in certain States
(1)In general The requirements of this section shall not apply with respect to health insurance coverage if there is a State law (as defined in section 1191(d)(1) of this title) for a State that regulates such coverage that is described in any of the following subparagraphs:
(A)Such State law requires such coverage to provide for at least a 48-hour hospital length of stay following a normal vaginal delivery and at least a 96-hour hospital length of stay following a cesarean section.
(B)Such State law requires such coverage to provide for maternity and pediatric care in accordance with guidelines established by the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, or other established professional medical associations.
(C)Such State law requires, in connection with such coverage for maternity care, that the hospital length of stay for such care is left to the decision of (or required to be made by) the attending provider in consultation with the mother.
(2)Construction Section 1191(a)(1) of this title shall not be construed as superseding a State law described in paragraph (1).
(Pub. L. 93–406, title I, § 711, as added Pub. L. 104–204, title VI, § 603(a)(5), Sept. 26, 1996, 110 Stat. 2935.)
Connections178 cite this · traces to 4
Cited by 178 sections · top 60
public-private-law
U.S. Code
register
statutes-at-large
- Public Law 116–260Making consolidated appropriations for the fiscal year ending September 30, 2021, providing coronavirus emergency response and relief, and for other purposes
- Public Law 110–381To amend the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code of 1986 to ensure that dependent students who take a medically necessary leave of absence do not lose health insurance coverage, and for other purposes
- Public Law 104–204Making appropriations for the Departments of Veterans Affairs and Housing and Urban Development, and for sundry independent agencies, boards, commissions, corporations, and offices for the fiscal year ending September 30, 1997, and for other purposes
- Public Law 105–276Making appropriations for the Departments of Veterans Affairs and Housing and Urban Development, and for sundry independent agencies, boards, commissions, corporations, and offices for the fiscal year ending September 30, 1999, and for other purposes
bill
- Sec. 3Amendments to the Employee Retirement Income Security Act of 1974
- Sec. 3Value requirements for dental benefits
- Sec. 301Coverage for treatment for eating disorders under group health plans, individual health insurance coverage, and FEHBP
- Sec. 3Prosthetics and custom orthotics fairness in coverage
- Sec. 3Value requirements for dental benefits
- Sec. 3Amendments to the Employee Retirement Income Security Act of 1974
- Sec. 3Amendments to the Employee Retirement Income Security Act of 1974
- Sec. 2Guaranteed availability of coverage; prohibiting discrimination
- Sec. 2Guaranteed availability of coverage; prohibiting discrimination
- Sec. 2Prohibition on surprise medical billing
- Sec. 2Coverage of additional preventive care for individuals with chronic conditions without imposition of cost sharing requirements
- Sec. 2Requirement for group health plans and health insurance issuers to establish a process to address inaccurate information listed in publicly accessible provider directories of such plans and issuers
- Sec. 2Requiring group health plans and health insurance issuers to include on any insurance card issued by such plan or issuer information on the nearest in-network hospital
- Sec. 2Prohibition on surprise medical billing
- Sec. 2Preventing surprise medical bills
- Sec. 6Improving provider directories
- Sec. 8Access to cost-sharing information
- Sec. 2Improving the availability and accuracy of provider directory information made available by group health plans and health insurance issuers offering group or individuals health insurance coverage
- Sec. 2Information required to be included on health insurance membership cards
- Sec. 2Requiring group health plans and health insurance issuers to provide for certain coverage in the case of a change in a provider’s network status
- Sec. 2Advanced explanation of benefits
- Sec. 2Consumer protections through requirements on health plans to prevent surprise medical bills for emergency services
- Sec. 9Additional consumer protections
- Sec. 70305Requiring prescription drug refill notifications during emergencies
- Sec. 2Requiring prescription drug refill notifications during emergencies
- Sec. 30304Requiring prescription drug refill notifications during emergencies
- Sec. 30304Requiring prescription drug refill notifications during emergencies
- Sec. 30304Requiring prescription drug refill notifications during emergencies
- Sec. 2Prohibiting a group health plan and a health insurance issuer offering group or individual health insurance coverage from reducing contracted rates, or terminating contracts, with health care providers during a public health emergency
- Sec. 2Insulin net price protection
- Sec. 2Providing for certain health coverage of newborns
- Sec. 2Prohibiting certain health plans from applying a deductible to outpatient pediatric services
- Sec. 2Establishment and maintenance of health care claims database to lower health care costs
- Sec. 2Prohibition on application of cost sharing for certain primary care and behavioral health care visits
- Sec. 201Guaranteed availability of coverage; prohibiting discrimination
- Sec. 1Reporting on pharmacy benefits and drug costs
- Sec. 2Providing for certain health coverage of newborns
- Sec. 2Prohibition on application of cost sharing for certain primary care and behavioral health care visits
- Sec. 2Prohibition on mandatory predispute arbitration and limitations on class action lawsuits
- Sec. 2Coverage of additional preventive care for individuals with chronic conditions without imposition of cost sharing requirements
- Sec. 2Coverage of hearing devices and systems in certain private health insurance plans
- Sec. 2Insulin net price protection
- Sec. 27001Requirements with respect to cost-sharing for certain insulin products
7 references not yet in our index
- 1
- Pub. L. 93–406, title I, § 711
- Pub. L. 104–204, title VI, § 603(a)(5)
- 110 Stat. 2935
- Pub. L. 105–34, title XV, § 1503(b)(1)(B)
- 111 Stat. 1061
- section 603(c) of Pub. L. 104–204
Citation graph
cites case law
§ 1185
Standards relating to benefits for mothers and newborns
Bills×143
Stat.×12
Pub. L.×9
Fed. Reg.×7
U.S.C.×7
Cite1
Pub. L.Pub. L. 93–406, title I, § 711
Pub. L.Pub. L. 104–204, title VI, § 603(a)(5)
Stat.110 Stat. 2935
Pub. L.Pub. L. 105–34, title XV, § 1503(b)(1)(B)
Cites 11 · showing 9Cited by 178 across 5 sources