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.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Postnatal Protection
Act of 1995’’.
SEC. 2. REQUIRED COVERAGE FOR MINIMUM HOSPITAL
STAY FOLLOWING BIRTH.
(a) IN GENERAL.—A health plan that provides ma-
ternity benefits, including benefits for child birth, shall en-
sure that coverage is provided for a minimum of 48 hours
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of in-patient care following a vaginal delivery and a mini-
mum of 96 hours of in-patient care following a caesarean
section for a mother and her newly born child in a health
care facility.
(b) EXCEPTION.—
(1) IN GENERAL.—Notwithstanding subsection
(a), a health plan that provides coverage for post-de-
livery care provided to a mother and her newly born
child in the home shall not be required to provide
coverage of in-patient care under subsection (a) un-
less such in-patient care is determined to be medi-
cally necessary by the attending physician or is re-
quested by the mother.
(2) ATTENDING PHYSICIAN.—For purposes of
paragraph (1), the term ‘‘attending physician’’ shall
include the obstetrician, pediatrician, or other physi-
cian attending the mother or newly born child.
(c) PROHIBITION.—In implementing the require-
ments of this section, a health plan may not modify the
terms and conditions of coverage based on the determina-
tion by an enrollee to request less than the minimum cov-
erage required under subsection (a).
(d) NOTICE.—A health plan shall provide notice to
each enrollee under such plan regarding the coverage re-
quired by this section in accordance with regulations pro-
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mulgated by the Secretary of Health and Human Services,
in consultation with the National Association of Insurance
Commissioners. Such notice shall be in writing and promi-
nently positioned in any literature or correspondence made
available or distributed by the health plan and shall be
transmitted—
(1) in the next mailing made by the plan to the
employee;
(2) as part of the yearly informational packet
sent to the enrollee; or
(3) not later than January 1, 1996;
whichever is earlier.
(e) HEALTH PLAN.—
(1) IN
GENERAL.—As used in this Act, 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.
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(C) A medicare supplemental policy (as de-
fined in section 1882(g)(1) of the Social Secu-
rity Act).
(D) Coverage issued as a supplement to li-
ability insurance.
(E) Worker’s compensation or similar in-
surance.
(F) Automobile medical-payment insur-
ance.
(G) A long-term care policy, including a
nursing home fixed indemnity policy (unless the
Secretary determines that such a policy pro-
vides 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 deter-
mines is not a health plan.
(3) CERTAIN PLANS INCLUDED.—Such term in-
cludes 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,
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without regard to the costs incurred or services ren-
dered during the period to which the payments re-
late.
SEC. 3. EFFECTIVE DATE.
The provisions of section 2 shall apply to all health
plans offered, sold, issued, or renewed after the date of
enactment of this Act.
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