Mothers' and Infants' Good Health Act of 1995

Summary: Mothers' and Infants' Good Health Act of 1995 - Requires a health plan that provides maternity benefits that include benefits for child birth to provide coverage for a minimum amount of time following delivery in:  (1) a health care facility; and (2) the home or other outpatient setting.  Prohibits a health plan from modifying the terms and conditions of coverage, if an enrollee requests less than the minimum coverage required in this Act. 
Requires a health plan to provide notice, as specified, to each enrollee regarding the coverage required in this Act. 
Establishes civil penalties for failure to provide coverage and failure to provide notice.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Mothers' and Infants' Good Health 
Act of 1995''.

SEC. 2. REQUIRED COVERAGE FOR CHILD BIRTH.

    (a) In General.--A health plan that provides maternity benefits 
that include benefits for child birth shall ensure that--
            (1) in the case of delivery in a hospital or other 
        inpatient setting, coverage is provided for a minimum of 48 
        hours of inpatient care following a vaginal delivery and a 
        minimum of 96 hours of inpatient care following a caesarean 
        section for a mother and her newly born child in a health care 
        facility; and
            (2) in the case of delivery in the home or other outpatient 
        setting, coverage for appropriate home health care in the 
        setting is provided for a minimum of 48 hours following 
        delivery.
    (b) Terms of Coverage.--A health plan fails to provide coverage 
required under subsection (a) if the plan imposes cost-sharing with 
respect to care described in such subsection which varies depending on 
the length of stay within the minimum period required under such 
subsection.
    (c) Prohibition.--In implementing the requirements of this section, 
a health plan may not modify the terms and conditions of coverage based 
on the determination by an enrollee to request less than the minimum 
coverage required under subsection (a).
    (d) Notice.--A health plan shall provide notice to each enrollee 
under such plan regarding the coverage required by this section in 
accordance with regulations promulgated by the Secretary of Health and 
Human Services, in consultation with the National Association of 
Insurance Commissioners. Such notice shall be in writing and 
prominently positioned in any literature or correspondence made 
available or distributed by the health plan and shall be transmitted--
            (1) in the next mailing of general information made by the 
        plan to the enrollee,
            (2) as part of the yearly informational packet sent to the 
        enrollee, or
            (3) not later than January 1, 1996,
whichever is earliest.
    (e) Enforcement.--
            (1) Failure to provide coverage.--Any health plan that 
        violates the provisions of this section (other than subsection 
        (d)) shall be subject to a civil money penalty in an amount 
        determined by the Secretary of Health and Human Services.
            (2) Failure to provide notice.--Any health plan that 
        violates the provisions of subsection (d) shall be subject to a 
        civil money penalty in an amount determined by the Secretary of 
        Health and Human Services.
            (3) Process.--The provisions of section 1128A of the Social 
        Security Act (other than subsections (a) and (b)) shall apply 
        to civil money penalties under this subsection in the same 
        manner as they apply to a penalty or proceeding under section 
        1128A(a) of such Act.
    (f) Health Plan.--
            (1) In general.--As used in this section, the term ``health 
        plan'' means any plan or arrangement which provides, or pays 
        the cost of, health benefits.
            (2) Exclusions.--Such term does not include the following, 
        or any combination thereof:
                    (A) Coverage only for accidental death or 
                dismemberment.
                    (B) Coverage providing wages or payments in lieu of 
                wages for any period during which the employee is 
                absent from work on account of sickness or injury.
                    (C) A medicare supplemental policy (as defined in 
                section 1882(g)(1) of the Social Security Act).
                    (D) Coverage issued as a supplement to liability 
                insurance.
                    (E) Worker's compensation or similar insurance.
                    (F) Automobile medical-payment insurance.
                    (G) A long-term care policy, including a nursing 
                home fixed indemnity policy (unless the Secretary 
                determines that such a policy provides sufficiently 
                comprehensive coverage of a benefit so that it should 
                be treated as a health plan).
                    (H) Such other plan or arrangement as the Secretary 
                of Health and Human Services determines is not a health 
                plan.
            (3) Certain plans included.--Such term includes any plan or 
        arrangement not described in any subparagraph of paragraph (2) 
        which provides for benefit payments, on a periodic basis, for--
                    (A) a specified disease or illness, or
                    (B) period of hospitalization,
        without regard to the costs incurred or services rendered 
        during the period to which the payments relate.

SEC. 3. EFFECTIVE DATE.

    The provisions of section 2 shall apply to all health plans 
offered, sold, issued, or renewed after the date of the enactment of 
this Act.