Does Newborns' & Moms' Act Expand Coverage Other than Time

[Guest Lyn6688]

I am reviewing the federal Newborns and Mothers Protection Act. The Act requires certain minimum stay provisions and says a plan cannot "restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child" to less than 48 or 96 hours, depending on the type of delivery. A client has a plan that does not provide well-child coverage of any kind. Question: does the federal law require the plan to cover all hospital stay expenses for a healthy newborn? Is there a valid argument that the stay is "in connection with childbirth" and thus any such expenses should be covered? Or would the expenses covered be just for the birth itself and not expenses thereafter for the newborn? Could failure to cover the newborn be deemed an incentive to get mom out of the hospital early (i.e. to avoid incurring uncovered baby expenses) that runs afoul of the federal law? The state insurance department tells me there is no state law mandating the well baby coverage, and I cannot find any other guidance on this issue. Does anyone have any idea whether the federal law essentially mandates healthy newborn coverage for the 48 to 96 hour period of minimum stay? I would appreciate your thoughts.

[Guest Brenda N.]

Did you ever find information regarding this? Are inpatient expenses for newborns required to be covered under this rule?

[Sandra Pearce]

The law does not mandate coverage.

[jeanine]

I think I would argue that this is not well baby coverage and cover it as a dependent expense. The baby is receiving care while in the hospital, including observation care. Observation care may be medically indicated and if so should be covered by the plan. I guess I'm struggling to understand just what the plan is trying to save here ($$wise). The bulk of the expense is going to be in the labor & delivery charges and postpartum for mom. If the child does actually rack up some charges, such as NICU, then it isn't well baby care either. I think this is a horrible public relations issue to put in front of your employees.

[Guest Cgross]

Wow. Some questions keep coming up! Was doing a search to try to answer this question and found this post.

Would appreciate the "experts" opinion on this situation.

Self funded plan covers newborn charges separate from mother. The newborn must be added to the plan during special enrollment in order for well baby hospital charges to be covered.

Mom has single coverage, but dad enrolled newborn dependent under his plan. Mom's plan denied coverage for the newborn, but the hospital is now saying that the 48/96 law mandates not only the time, but that the newborn and Mom be paid as one claim.

I think that the following section would not require a plan to cover this:

"This section shall not apply with respect to any group health plan, or any group health insurance coverage offered by a health insurance issuer, which does not provide benefits for hospital lengths of stay in connection with childbirth for a mother or her newborn child"..

Any opinions? Thanks.