|- Health Benefits Advisor for Employers|
The Newborns’ and Mothers’ Health Protection Act of 1996
General 48/96-Hour Stay Rule
Group health plans generally may not restrict benefits for a hospital length of stay in connection with childbirth to less than 48 hours in the case of a vaginal delivery, or less than 96 hours in the case of a cesarean section.
A plan cannot deny a mother or her newborn hospital length of stay benefits within a 48/96-hour stay based on medical necessity. (A plan may require a mother to notify the plan of a pregnancy to obtain more favorable cost-sharing for the hospital stay. This second type of plan provision is permissible under the Newborns’ Act if the cost-sharing is consistent throughout the 48/96-hour stay.)
An attending provider may, however, decide, in consultation with the mother, to discharge the mother or newborn earlier.
In order to comply with the federal Newborns’ Act, your plan must follow the general 48/96-hour stay rule.
Does your plan offer mothers and their newborns hospital stays of at least 48 hours in the case of a vaginal delivery, and at least 96 hours in the case of a cesarean section?