I

104TH CONGRESS

1ST SESSION H. R. 1968

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 29, 1995

Mr. SOLOMON 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 ‘‘Postnatal Protection

5 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 in-patient care following a vaginal delivery and a mini2 mum of 96 hours of in-patient 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 in the home shall not be required to provide

10 coverage of in-patient care under subsection (a) un11 less such in-patient care is determined to be medi12 cally necessary by the attending physician or is re13 quested 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) PROHIBITION.—In implementing the require19 ments of this section, a health plan may not modify the

20 terms and conditions of coverage based on the determina21 tion by an enrollee to request less than the minimum cov22 erage required under subsection (a).

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

24 each enrollee under such plan regarding the coverage re25 quired by this section in accordance with regulations pro-
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1 mulgated by the Secretary of Health and Human Services,

2 in consultation with the National Association of Insurance

3 Commissioners. Such notice shall be in writing and promi4 nently positioned in any literature or correspondence made

5 available or distributed by the health plan and shall be

6 transmitted—

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

8 employee;

9 (2) as part of the yearly informational packet

10 sent to the enrollee; or

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

12 whichever is earlier.

13 (e) HEALTH PLAN.—

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

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

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

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

18 the following, or any combination thereof:

19 (A) Coverage only for accidental death or

20 dismemberment.

21 (B) Coverage providing wages or payments

22 in lieu of wages for any period during which the

23 employee is absent from work on account of

24 sickness or injury.
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1 (C) A medicare supplemental policy (as de2 fined in section 1882(g)(1) of the Social Secu3 rity Act).

4 (D) Coverage issued as a supplement to li5 ability insurance.

6 (E) Worker’s compensation or similar in7 surance.

8 (F) Automobile medical-payment insur9 ance.

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

11 nursing home fixed indemnity policy (unless the

12 Secretary determines that such a policy pro13 vides sufficiently comprehensive coverage of a

14 benefit so that it should be treated as a health

15 plan).

16 (H) Such other plan or arrangement as the

17 Secretary of Health and Human Services deter18 mines is not a health plan.

19 (3) CERTAIN PLANS INCLUDED.—Such term in20 cludes any plan or arrangement not described in any

21 subparagraph of paragraph (2) which provides for

22 benefit payments, on a periodic basis, for—

23 (A) a specified disease or illness, or

24 (B) period of hospitalization,
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1 without regard to the costs incurred or services ren2 dered during the period to which the payments re3 late.

4 SEC. 3. EFFECTIVE DATE.

5 The provisions of section 2 shall apply to all health

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

7 enactment of this Act.

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