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The Newborns’ and Mothers’ Health Protection Act (NMHPA) includes important protections for mothers and their newborn children with regard to the length of a hospital stay following childbirth. The NMHPA affects the amount of time a mother and her newborn child are covered for a hospital stay following childbirth.
The type of coverage provided by your plan (insured vs. self-insured) and state law will determine whether the NMHPA applies to a mother’s or a newborn’s coverage.
Self-Insured coverage is subject to the NMHPA.
If this is the case, the state law may differ slightly from the NMHPA requirements, so it is important for you to know which law applies to your coverage.
You should contact your State Insurance Commissioner’s Office for the most current information.
Group health plans, insurance companies and health maintenance organizations (HMOs) that are subject to the NMHPA may not restrict benefits for a hospital stay in connection with childbirth to less than 48 hours following a vaginal delivery or 96 hours following a delivery by cesarean section.
A plan, insurance company or HMO cannot deny the mother of her newborn child coverage for a 48-hour stay (or 96-hour stay) because the plan claims that the mother or her attending provider, have failed to show that the 48-hour stay (or 96-hour stay) is medically necessary.
The NMHPA does not require plans, insurance companies or HMOs to provide coverage for hospital stays in connection with childbirth. However, if this coverage is offered, the NMHPA applies.
A plan subject to NMHPA must include a description of the NMHPA’s requirements for hospital stays for newborns and mothers in its Summary Plan Description (SPD). If state law applies to a fully-insured plan, the SPD should describe the applicable benefits/requirements. In cases where an employer has both self-insured and fully-insured plans in different areas, the SPD should describe the areas and the applicable requirements in each.
Click Here for sample language of the NMHPA notice.
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