[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1968 Introduced in House (IH)]







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 Representatives 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 maternity benefits, 
including benefits for child birth, shall ensure that coverage is 
provided for a minimum of 48 hours of in-patient care following a 
vaginal delivery and a minimum 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-delivery 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) unless such in-patient care is determined to be 
        medically necessary by the attending physician or is requested 
        by the mother.
            (2) Attending physician.--For purposes of paragraph (1), 
        the term ``attending physician'' shall include the 
        obstetrician, pediatrician, or other physician attending the 
        mother or newly born child.
    (c) Prohibition.--In implementing the requirements of this section, 
a health plan may not modify the terms and conditions of coverage based 
on the determination by an enrollee to request less than the minimum 
coverage required under subsection (a).
    (d) Notice.--A health plan shall provide notice to each enrollee 
under such plan regarding the coverage required by this section in 
accordance with regulations promulgated by the Secretary of Health and 
Human Services, in consultation with the National Association of 
Insurance Commissioners. Such notice shall be in writing and 
prominently 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.
                    (C) A medicare supplemental policy (as defined in 
                section 1882(g)(1) of the Social Security Act).
                    (D) Coverage issued as a supplement to liability 
                insurance.
                    (E) Worker's compensation or similar insurance.
                    (F) Automobile medical-payment insurance.
                    (G) A long-term care policy, including a nursing 
                home fixed indemnity policy (unless the Secretary 
                determines that such a policy provides 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 determines is not a health 
                plan.
            (3) Certain plans included.--Such term includes 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,
        without regard to the costs incurred or services rendered 
        during the period to which the payments relate.

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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