Search Frequenty Asked Questions

General Questions and Answers on the Newborns' and Mothers' Health Protection Act

Questions:

1. Does the 48-hour period (or 96-hour period) apply only to me, or does it also apply to my newborn child?
2. May a plan or an issuer require me to get permission for a 48-hour or 96-hour hospital stay?
3. May plans or health insurance issuers impose deductibles or other cost-sharing arrangements for hospital stays in connection with childbirth?
4. May I be offered incentives to shorten my hospital stay or my newborn's hospital stay? May my doctor be offered incentives to discharge us?
5. Is my health plan required to give me notice about my rights under NMHPA?

Answers:

1) Does the 48-hour period (or 96-hour period) apply only to me, or does it also apply to my newborn child?

The 48-hour period (or 96-hour period) applies to your newborn child and is independent of the period that applies to you. This means that the plan or issuer might pay for a different amount of time for you than for your child, depending on the attending provider's decision to discharge one of you before the other. The attending provider will make that decision in consultation with you.

2) May a plan or an issuer require me to get permission (sometimes called prior authorization or precertification based upon medical necessity) for a 48-hour or 96-hour hospital stay?

No. A plan or health insurance issuer cannot require you or your attending provider to show that the 48-hour (or 96-hour) stay is medically necessary. However, a plan or health insurance issuer may require you to get permission - sometimes called prior authorization or precertification based upon medical necessity - for any portion of a stay after the 48 hours (or 96 hours). In addition, a plan or health insurance issuer generally can require you to notify the plan or issuer of the pregnancy in advance of an admission if you wish to use certain providers or facilities, or to reduce your out-of-pocket costs.

3) May plans or health insurance issuers impose deductibles or other cost-sharing arrangements for hospital stays in connection with childbirth?

Yes, but only if the deductible, coinsurance, or other cost-sharing amounts for the later part of the protected 48-hour (or 96-hour) stay are not greater than those imposed for the earlier part of the stay. For example, with respect to a 48-hour stay, a plan is permitted to cover only 80 percent of the cost of the hospital stay. However, a plan that covers 80 percent of the cost for the first 24 hours cannot reduce coverage to 50 percent for the second 24 hours.

4) May I be offered incentives to shorten my hospital stay or my newborn's hospital stay? May my doctor be offered incentives to discharge us?

No. Plans and health insurance issuers cannot give you payments (including payments-in-kind such as baby supplies) or rebates in return for your agreeing to an early discharge. Plans and health insurance issuers are prohibited from pressuring you to agree to an early discharge. They may not deny you or your newborn child eligibility or continued eligibility to enroll or renew coverage under your plan or individual policy. Plans and health insurance issuers cannot pressure attending providers to discharge you or your newborn child early by giving them financial or other incentives. Such illegal incentives would include reducing or limiting their compensation or by penalizing them, for example, by taking disciplinary action against them.

5) Is my health plan required to give me notice about my rights under NMHPA?

Yes. Group health plans and health insurance issuers are required to provide you with notice about your rights under this law. If you are in a group health plan, the notice will usually be included in the plan document (sometimes referred to as the 'Summary Plan Description') that provides a description of the benefits covered under your plan. If you have individual health insurance coverage, the notice of your rights under NMHPA will generally be included in your insurance contract.