
From the U.S. Code Online via GPO Access
[wais.access.gpo.gov]
[Laws in effect as of January 2, 2001]
[Document not affected by Public Laws enacted between
  January 2, 2001 and January 28, 2002]
[CITE: 26USC9811]

 
                     TITLE 26--INTERNAL REVENUE CODE
 
               Subtitle K--Group Health Plan Requirements
 
               CHAPTER 100--GROUP HEALTH PLAN REQUIREMENTS
 
                    Subchapter B--Other Requirements
 
Sec. 9811. Standards relating to benefits for mothers and 
        newborns
        

(a) Requirements for minimum hospital stay following birth

                           (1) In general

        A group health plan may not--
            (A) except as provided in paragraph (2)--
                (i) restrict benefits for any hospital length of stay in 
            connection with childbirth for the mother or newborn child, 
            following a normal vaginal delivery, to less than 48 hours, 
            or
                (ii) restrict benefits for any hospital length of stay 
            in connection with childbirth for the mother or newborn 
            child, following a caesarean section, to less than 96 hours; 
            or

            (B) require that a provider obtain authorization from the 
        plan or the issuer for prescribing any length of stay required 
        under subparagraph (A) (without regard to paragraph (2)).

                            (2) Exception

        Paragraph (1)(A) shall not apply in connection with any group 
    health plan in any case in which the decision to discharge the 
    mother or her newborn child prior to the expiration of the minimum 
    length of stay otherwise required under paragraph (1)(A) is made by 
    an attending provider in consultation with the mother.

(b) Prohibitions

    A group health plan may not--
        (1) deny to the mother or her newborn child eligibility, or 
    continued eligibility, to enroll or to renew coverage under the 
    terms of the plan, solely for the purpose of avoiding the 
    requirements of this section;
        (2) provide monetary payments or rebates to mothers to encourage 
    such mothers to accept less than the minimum protections available 
    under this section;
        (3) penalize or otherwise reduce or limit the reimbursement of 
    an attending provider because such provider provided care to an 
    individual participant or beneficiary in accordance with this 
    section;
        (4) provide incentives (monetary or otherwise) to an attending 
    provider to induce such provider to provide care to an individual 
    participant or beneficiary in a manner inconsistent with this 
    section; or
        (5) subject to subsection (c)(3), restrict benefits for any 
    portion of a period within a hospital length of stay required under 
    subsection (a) in a manner which is less favorable than the benefits 
    provided for any preceding portion of such stay.

(c) Rules of construction

    (1) Nothing in this section shall be construed to require a mother 
who is a participant or beneficiary--
        (A) to give birth in a hospital; or
        (B) to stay in the hospital for a fixed period of time following 
    the birth of her child.

    (2) This section shall not apply with respect to any group health 
plan which does not provide benefits for hospital lengths of stay in 
connection with childbirth for a mother or her newborn child.
    (3) Nothing in this section shall be construed as preventing a group 
health plan from imposing deductibles, coinsurance, or other cost-
sharing in relation to benefits for hospital lengths of stay in 
connection with childbirth for a mother or newborn child under the plan, 
except that such coinsurance or other cost-sharing for any portion of a 
period within a hospital length of stay required under subsection (a) 
may not be greater than such coinsurance or cost-sharing for any 
preceding portion of such stay.

(d) Level and type of reimbursements

    Nothing in this section shall be construed to prevent a group health 
plan from negotiating the level and type of reimbursement with a 
provider for care provided in accordance with this section.

(e) Preemption; exception for health insurance coverage in certain 
        States

    The requirements of this section shall not apply with respect to 
health insurance coverage if there is a State law (including a decision, 
rule, regulation, or other State action having the effect of law) for a 
State that regulates such coverage that is described in any of the 
following paragraphs:
        (1) Such State law requires such coverage to provide for at 
    least a 48-hour hospital length of stay following a normal vaginal 
    delivery and at least a 96-hour hospital length of stay following a 
    caesarean section.
        (2) Such State law requires such coverage to provide for 
    maternity and pediatric care in accordance with guidelines 
    established by the American College of Obstetricians and 
    Gynecologists, the American Academy of Pediatrics, or other 
    established professional medical associations.
        (3) Such State law requires, in connection with such coverage 
    for maternity care, that the hospital length of stay for such care 
    is left to the decision of (or required to be made by) the attending 
    provider in consultation with the mother.

(Added Pub. L. 105-34, title XV, Sec. 1531(a)(4), Aug. 5, 1997, 111 
Stat. 1081; amended Pub. L. 105-206, title VI, Sec. 6015(e), July 22, 
1998, 112 Stat. 821.)


                               Amendments

    1998--Subsecs. (e), (f). Pub. L. 105-206 redesignated subsec. (f) as 
(e).


                    Effective Date of 1998 Amendment

    Amendment by Pub. L. 105-206 effective, except as otherwise 
provided, as if included in the provisions of the Taxpayer Relief Act of 
1997, Pub. L. 105-34, to which such amendment relates, see section 6024 
of Pub. L. 105-206, set out as a note under section 1 of this title.


                             Effective Date

    Subchapter applicable with respect to group health plans for plan 
years beginning on or after Jan. 1, 1998, see section 1531(c) of Pub. L. 
105-34, set out as an Effective Date of 1997 Amendment note under 
section 4980D of this title.

                  Section Referred to in Other Sections

    This section is referred to in section 4980D of this title.
