I

104TH CONGRESS

1ST SESSION H. R. 1970

To require that health plans provide coverage for minimum period of time

for a mother and child following the birth of the child.

IN THE HOUSE OF REPRESENTATIVES

JUNE 29, 1995

Mr. TORRICELLI (for himself, Mr. NADLER, Mr. SANDERS, Mr. DEFAZIO, and

Mr. PALLONE) introduced the following bill; which was referred to the

Committee on Commerce

A BILL

To require that health plans provide coverage for minimum

period of time for a mother and child following the

birth of the child.

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 ‘‘Mothers’ and Infants’

5 Good Health Act of 1995’’.

6 SEC. 2. REQUIRED COVERAGE FOR CHILD BIRTH.

7 (a) IN GENERAL.—A health plan that provides ma8 ternity benefits that include benefits for child birth shall

9 ensure that—
2

•HR 1970 IH

1 (1) in the case of delivery in a hospital or other

2 inpatient setting, coverage is provided for a mini3 mum of 48 hours of inpatient care following a vagi4 nal delivery and a minimum of 96 hours of inpatient

5 care following a caesarean section for a mother and

6 her newly born child in a health care facility; and

7 (2) in the case of delivery in the home or other

8 outpatient setting, coverage for appropriate home

9 health care in the setting is provided for a minimum

10 of 48 hours following delivery.

11 (b) TERMS OF COVERAGE.—A health plan fails to

12 provide coverage required under subsection (a) if the plan

13 imposes cost-sharing with respect to care described in such

14 subsection which varies depending on the length of stay

15 within the minimum period required under such sub16 section.

17 (c) PROHIBITION.—In implementing the require18 ments of this section, a health plan may not modify the

19 terms and conditions of coverage based on the determina20 tion by an enrollee to request less than the minimum cov21 erage required under subsection (a).

22 (d) NOTICE.—A health plan shall provide notice to

23 each enrollee under such plan regarding the coverage re24 quired by this section in accordance with regulations pro25 mulgated by the Secretary of Health and Human Services,
3

•HR 1970 IH

1 in consultation with the National Association of Insurance

2 Commissioners. Such notice shall be in writing and promi3 nently positioned in any literature or correspondence made

4 available or distributed by the health plan and shall be

5 transmitted—

6 (1) in the next mailing of general information

7 made by the plan to the enrollee,

8 (2) as part of the yearly informational packet

9 sent to the enrollee, or

10 (3) not later than January 1, 1996,

11 whichever is earliest.

12 (e) ENFORCEMENT.—

13 (1) FAILURE TO PROVIDE COVERAGE.—Any

14 health plan that violates the provisions of this sec15 tion (other than subsection (d)) shall be subject to

16 a civil money penalty in an amount determined by

17 the Secretary of Health and Human Services.

18 (2) FAILURE TO PROVIDE NOTICE.—Any health

19 plan that violates the provisions of subsection (d)

20 shall be subject to a civil money penalty in an

21 amount determined by the Secretary of Health and

22 Human Services.

23 (3) PROCESS.—The provisions of section 1128A

24 of the Social Security Act (other than subsections

25 (a) and (b)) shall apply to civil money penalties
4

•HR 1970 IH

1 under this subsection in the same manner as they

2 apply to a penalty or proceeding under section

3 1128A(a) of such Act.

4 (f) HEALTH PLAN.—

5 (1) IN GENERAL.—As used in this section, the

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

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

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

9 the following, or any combination thereof:

10 (A) Coverage only for accidental death or

11 dismemberment.

12 (B) Coverage providing wages or payments

13 in lieu of wages for any period during which the

14 employee is absent from work on account of

15 sickness or injury.

16 (C) A medicare supplemental policy (as de17 fined in section 1882(g)(1) of the Social Secu18 rity Act).

19 (D) Coverage issued as a supplement to li20 ability insurance.

21 (E) Worker’s compensation or similar in22 surance.

23 (F) Automobile medical-payment insur24 ance.
5

•HR 1970 IH

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

2 nursing home fixed indemnity policy (unless the

3 Secretary determines that such a policy pro4 vides sufficiently comprehensive coverage of a

5 benefit so that it should be treated as a health

6 plan).

7 (H) Such other plan or arrangement as the

8 Secretary of Health and Human Services deter9 mines is not a health plan.

10 (3) CERTAIN PLANS INCLUDED.—Such term in11 cludes any plan or arrangement not described in any

12 subparagraph of paragraph (2) which provides for

13 benefit payments, on a periodic basis, for—

14 (A) a specified disease or illness, or

15 (B) period of hospitalization,

16 without regard to the costs incurred or services ren17 dered during the period to which the payments re18 late.

19 SEC. 3. EFFECTIVE DATE.

20 The provisions of section 2 shall apply to all health

21 plans offered, sold, issued, or renewed after the date of

22 the enactment of this Act.

Æ