Internal Revenue Code:Sec. 9811. Standards relating to benefits for mothers and newborns

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Location in Internal Revenue Code

     TITLE 26 - INTERNAL REVENUE CODE
      Subtitle K - Group Health Plan Requirements
       CHAPTER 100 - GROUP HEALTH PLAN REQUIREMENTS
        Subchapter B - Other Requirements
      

Statute

    Sec. 9811. Standards relating to benefits for mothers and newborns
 
    (a) Requirements for minimum hospital stay following birth
      (1) In general
        A group health plan 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 caesarean 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 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 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 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 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, 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) Level and type of reimbursements
      Nothing in this section shall be construed to prevent a group
    health plan from negotiating the level and type of reimbursement
    with a provider for care provided in accordance with this section.
    (e) Preemption; exception for health insurance coverage in certain
        States
      The requirements of this section shall not apply with respect to
    health insurance coverage if there is a State law (including a
    decision, rule, regulation, or other State action having the effect
    of law) for a State that regulates such coverage that is described
    in any of the following paragraphs:
        (1) 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 caesarean section.
        (2) 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.
        (3) 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.
 

Sources

    (Added Pub. L. 105-34, title XV, Sec. 1531(a)(4), Aug. 5, 1997, 111
    Stat. 1081; amended Pub. L. 105-206, title VI, Sec. 6015(e), July
    22, 1998, 112 Stat. 821.)
 

Miscellaneous

                                 AMENDMENTS
      1998 - Subsecs. (e), (f). Pub. L. 105-206 redesignated subsec.
    (f) as (e).
                      EFFECTIVE DATE OF 1998 AMENDMENT
      Amendment by Pub. L. 105-206 effective, except as otherwise
    provided, as if included in the provisions of the Taxpayer Relief
    Act of 1997, Pub. L. 105-34, to which such amendment relates, see
    section 6024 of Pub. L. 105-206, set out as a note under section 1
    of this title.
                               EFFECTIVE DATE
      Subchapter applicable with respect to group health plans for plan
    years beginning on or after Jan. 1, 1998, see section 1531(c) of
    Pub. L. 105-34, set out as an Effective Date of 1997 Amendment note
    under section 4980D of this title.
 

References

                   SECTION REFERRED TO IN OTHER SECTIONS
      This section is referred to in section 4980D of this title.