29 U.S.C. § 1185 — Standards relating to benefits for mothers and newborns

(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) limit benefits for the mother’s or newborn child’s hospital stay connected with childbirth after a normal vaginal delivery to fewer than 48 hours; or

(ii) limit those benefits after a cesarean section to fewer than 96 hours; or

(B) require a provider to get authorization from the plan^* or issuer before prescribing any length of stay required under subparagraph (A), without applying the exception in paragraph (2).

(2) Exception. Paragraph (1)(A) does not apply when an attending provider, after consulting with the mother, decides to discharge the mother or newborn child before the minimum stay otherwise required by paragraph (1)(A) ends.

(b) Prohibitions. A group health plan and a health insurance issuer offering group health insurance coverage^* connected with a group health plan may not—

(1) deny the mother or newborn child eligibility, or continued eligibility, to enroll in or renew coverage under the plan’s terms solely to avoid this section’s requirements;

(2) give mothers money or rebates to encourage them to accept less than this section’s minimum protections;

(3) penalize an attending provider, or reduce or limit the provider’s reimbursement, because the provider cared for an individual participant^* or beneficiary^* in accordance with this section;

(4) give an attending provider a monetary or other incentive to cause the provider to care for an individual participant or beneficiary in a way inconsistent with this section; or

(5) subject to subsection (c)(3), limit benefits for any part of a hospital stay required under subsection (a) in a way less favorable than the benefits for any earlier part of that stay.

(c) Rules of construction. (1) Nothing in this section requires a mother who is a participant or beneficiary—

(A) to give birth in a hospital; or

(B) to remain in the hospital for a fixed period after the child’s birth.

(2) This section does not apply to a group health plan or group health insurance coverage that does not provide benefits for a mother’s or newborn child’s hospital stay connected with childbirth.

(3) Nothing in this section prevents a group health plan or issuer from imposing deductibles, coinsurance, or other cost-sharing for childbirth-related hospital-stay benefits under the plan or connected group coverage. However, for any part of a hospital stay required under subsection (a), the coinsurance or other cost-sharing may not be greater than it is for any earlier part of that stay.

(d) Notice under group health plan. Imposing this section’s requirements is treated as a material change in the plan’s terms described in section 1022(a)(1) of this title, for purposes of ensuring that the plan gives notice of the requirements. The summary description required by the last sentence of section 1024(b)(1) of this title for that change must be provided no later than 60 days after the first day of the first plan year^* in which the requirements apply.

(e) Level and type of reimbursements. Nothing in this section prevents a group health plan or a health insurance issuer offering group health insurance coverage from negotiating with a provider about the amount and type of reimbursement for care provided in accordance with this section.

(f) Preemption; exception for health insurance coverage in certain States. (1) In general. This section’s requirements do not apply to health insurance coverage if a State^* law, as defined in section 1191(d)(1) of this title, regulates that coverage and meets one of these descriptions:

(A) The State law requires the coverage to provide at least a 48-hour hospital stay after a normal vaginal delivery and at least a 96-hour stay after a cesarean section.

(B) The State law requires the coverage to provide maternity and pediatric care according to guidelines established by the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, or another established professional medical association.

(C) For maternity care under the coverage, the State law requires the hospital-stay length to be left to, or required to be decided by, the attending provider in consultation with the mother.

(2) Construction. Section 1191(a)(1) of this title must not be interpreted as overriding a State law described in paragraph (1).