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Newborns' and Mothers' Health Protection Act


The Newborns' and Mothers' Health Protection Act ("Newborns' Act") is a healthcare reform law signed into law in 1996 which requires all health plans that offer maternity coverage to provide coverage for at least 48 hours following traditional childbirth or 96 hours following birth by caesarian section.

 

Applicability and Effective Date

The Newborns' Act applies to all self-funded plans that provide maternity coverage with plan years beginning on or after January 1, 1998. For insured plans, specific state laws may apply in lieu of the Newborns' Act if the state law provides greater protection.

 

Requirements

The Newborns' Act requires a baseline level of maternity coverage for all individual and group health plans that provide maternity benefits. Maternity coverage must be maintained for at least 48 hours following vaginal childbirth or 96 hours following birth by caesarian section if delivery occurs within the hospital. However, if delivery occurs outside of the hospital but the mother and/or newborn is subsequently admitted to the hospital in connection with the delivery, the 48-hour period begins at the time of admission. The standards of care implemented by this law are required baselines and no plan may require a covered person to prove medical necessity. Covered persons cannot be encouraged or otherwise incentivized to waive or otherwise restrict this minimum level of coverage, nor can a provider be pressured to release a mother and her newborn early.

 

Cost-sharing (deductibles, copays and coinsurance) may apply to maternity coverage, but may not be increased or otherwise altered for the latter part of the maternity stay.

 

ERISA plans must include a statement outlining these rights in their plans' Summary Plan Descriptions.

 

This content is being provided as an informational tool. It is believed to be accurate at the time of posting and is subject to change. It is recommended that plans consult with their own experts or counsel to review all applicable federal and state legal requirements that may apply to their group health plan. By providing this information, Meritain Health is not exercising discretionary authority or assuming a plan fiduciary role, nor is Meritain Health providing legal advice.