Health Insurance Coverage Problems Related to Childbirth and Pregnancy
Part 2, Chapter 4: Traditional Individual and Group Plans, Doctors' Bills Page 12
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Over the past few years, one of the major issues in the health insurance field has revolved around the number of days of hospital care that should be covered by a health insurance policy for childbirth. Many people have felt strongly that the standard hospital stay for childbirth should be at least 48 hours. A number of state legislatures have discussed the issue, and several states have passed legislation to require insurers that offer coverage for childbirth to provide coverage for a full 48 hours in the hospital. However, state laws that relate to benefits apply only to health insurance policies within the particular state, and do not generally apply to self-funded plans, since such plans are regulated through federal law rather than through state laws.
In order to deal with this issue on a national basis, the federal government passed the Newborns' and Mothers' Health Protection Act in the fall of 1996. The act is effective as of January 1, 1998. Although it does not require insurers to provide coverage for childbirth, the Newborns' and Mothers' Health Protection Act does require that health insurance policies and self-funded plans that do offer such coverage must provide benefits for a full 48 hours of hospital care following childbirth, and 96 hours of hospital care following a Caesarean delivery. However, in certain situations state law may take precedence in terms of health insurance coverage for childbirth, particularly if the state has passed a law providing for similar requirements.
In addition, the Portability and Accountability Act -- passed in 1996 -- provides that group health insurance plans may not generally consider pregnancy to be a pre-existing condition. That provision becomes effective as group plans are first renewed after July 1, 1997.
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