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104TH CONGRESS

1ST SESSION H. R. 1950

To require that health plans provide coverage for a minimum hospital stay

for a mother and child following the birth of the child, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

JUNE 28, 1995

Mr. PALLONE (for himself and Mr. TORRICELLI) introduced the following bill;

which was referred to the Committee on Commerce

A BILL

To require that health plans provide coverage for a minimum

hospital stay for a mother and child following the birth

of the child, and for other purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Newborns’ and Moth5 ers’ Health Protection Act of 1995’’.

6 SEC. 2. REQUIRED COVERAGE FOR MINIMUM HOSPITAL

7 STAY FOLLOWING BIRTH.

8 (a) IN GENERAL.—A health plan that provides ma9 ternity benefits, including benefits for child birth, shall en10 sure that coverage is provided for a minimum of 48 hours
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1 of inpatient care following a vaginal delivery and a mini2 mum of 96 hours of inpatient care following a caesarean

3 section for a mother and her newly born child in a health

4 care facility.

5 (b) EXCEPTION.—

6 (1) IN GENERAL.—Notwithstanding subsection

7 (a), a health plan that provides coverage for post-de8 livery care provided to a mother and her newly born

9 child other than in an inpatient setting shall not be

10 required to provide coverage of inpatient care under

11 subsection (a) unless such inpatient care is deter12 mined to be medically necessary by the attending

13 physician or is requested by the mother.

14 (2) ATTENDING PHYSICIAN.—For purposes of

15 paragraph (1), the term ‘‘attending physician’’ shall

16 include the obstetrician, pediatrician, or other physi17 cian attending the mother or newly born child.

18 (c) NOTICE.—A health plan shall provide notice to

19 each enrollee under such plan regarding the coverage re20 quired by this section in accordance with regulations pro21 mulgated by the Secretary of Health and Human Services,

22 in consultation with the National Association of Insurance

23 Commissioners. Such notice shall be in writing and promi24 nently positioned in any literature or correspondence made
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1 available or distributed by the health plan and shall be

2 transmitted—

3 (1) in the next mailing made by the plan to the

4 employee;

5 (2) as part of the yearly informational packet

6 sent to the enrollee; or

7 (3) not later than January 1, 1996;

8 whichever is earlier.

9 (d) HEALTH PLAN.—

10 (1) IN GENERAL.—As used in this Act, the

11 term ‘‘health plan’’ means any plan or arrangement

12 which provides, or pays the cost of, health benefits.

13 (2) EXCLUSIONS.—Such term does not include

14 the following, or any combination thereof:

15 (A) Coverage only for accidental death or

16 dismemberment.

17 (B) Coverage providing wages or payments

18 in lieu of wages for any period during which the

19 employee is absent from work on account of

20 sickness or injury.

21 (C) A medicare supplemental policy (as de22 fined in section 1882(g)(1) of the Social Secu23 rity Act).

24 (D) Coverage issued as a supplement to li25 ability insurance.
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1 (E) Worker’s compensation or similar in2 surance.

3 (F) Automobile medical-payment insur4 ance.

5 (G) A long-term care policy, including a

6 nursing home fixed indemnity policy (unless the

7 Secretary determines that such a policy pro8 vides sufficiently comprehensive coverage of a

9 benefit so that it should be treated as a health

10 plan).

11 (H) Such other plan or arrangement as the

12 Secretary of Health and Human Services deter13 mines is not a health plan.

14 (3) CERTAIN PLANS INCLUDED.—Such term in15 cludes any plan or arrangement not described in any

16 subparagraph of paragraph (2) which provides for

17 benefit payments, on a periodic basis, for—

18 (A) a specified disease or illness, or

19 (B) period of hospitalization,

20 without regard to the costs incurred or services ren21 dered during the period to which the payments re22 late.

23 SEC. 3. EFFECTIVE DATE.

24 The provisions of section 2 shall apply to all health

25 plans offered, sold, issued, or renewed after the expiration
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1 of the 1-year period which begins on the date of enactment

2 of this Act.

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