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The Newborns’ and Mothers’ Health Protection Act of 1996 (the
Newborns’ Act), signed into law on September 26, 1996, requires plans that
offer maternity coverage to pay for at least a 48-hour hospital stay
following childbirth (96-hour stay in the case of a cesarean section).
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This law was effective for group health plans for plan years beginning on or
after January 1, 1998.
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On October 27, 1998, the Department of Labor, in
conjunction with the Departments of the Treasury and Health and Human
Services, published interim regulations clarifying issues arising under the
Newborns’ Act. The changes made by the regulations are effective for group
health plans for plan years beginning on or after January 1, 1999.
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The Newborns’ Act and its regulations provide that health plans and
insurance issuers may not restrict a mother’s or newborn’s benefits for
a hospital length of stay that is connected to childbirth to less than 48
hours following a vaginal delivery or 96 hours following a delivery by
cesarean section. However, the attending provider (who may be a physician or
nurse midwife) may decide, after consulting with the mother, to discharge
the mother or newborn child earlier.
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The Newborns’ Act, and its regulations, prohibit incentives (either
positive or negative) that could encourage less than the minimum protections
under the Act as described above.
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A mother cannot be encouraged to accept less than the minimum protections
available to her under the Newborns’ Act and an attending provider cannot
be induced to discharge a mother or newborn earlier than 48 or 96 hours
after delivery.
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The type of coverage provided by the plan (insured or
self-insured) and state law will determine whether the Newborns’ Act
applies to a mother’s or newborn’s coverage.
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The Newborns’ Act provisions always apply to coverage that is
self-insured.
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For coverage that is insured, if your state has a law that meets certain
criteria, state law applies to your coverage rather than the Newborns’
Act. A list of states in which the federal Newborns’ Act
requirements apply as of July 1, 1998 can be found in the booklet Questions
and Answers: Recent Changes in Health Care Law.
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All group health plans that provide maternity or newborn infant coverage
must include a statement in their summary plan description (SPD) advising
individuals of the Newborns’ Act requirements.
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