A plan that covers childbirth cannot cut the hospital stay short.

The Hospital Stay Checklist.

General information, not legal or tax advice. Check the cited sources before you act.

• 48 hours after a vaginal delivery. The plan may not limit hospital stay benefits for the mother or newborn to less than 48 hours. ERISA 711(a)(1), 29 U.S.C. 1185(a)(1).
• 96 hours after a cesarean section. The same floor, at 96 hours, applies after a cesarean section.
• No pre-approval to stay that long. The plan may not require the provider to get authorization from the plan or insurer to prescribe a stay of those lengths.
• Early discharge is the provider’s call. The floors do not apply when the attending provider, in consultation with the mother, decides to discharge the mother or newborn sooner. 1185(a)(2).
• No pressure on mothers or providers. Under 1185(b), the plan may not deny or end eligibility to avoid the rule, pay a mother to accept less, penalize or cut reimbursement to a provider for care under the rule, or give a provider incentives to provide less care.
• Cost sharing. Deductibles and coinsurance are allowed, but cost sharing for any later part of the required stay may not exceed cost sharing for earlier parts. 1185(c)(3).

Who To Contact.

Ask the carrier or administrator whether the summary plan description statement is included and whether any maternity benefit is paid by day count. Ask whether the insured product relies on a state law in place of the federal rule. Section 711(f) lets certain state laws take the place of the federal text for insured coverage, so the carrier should say which one applies. Our guide on the Newborns’ and Mothers’ Health Protection Act has the wider background.

Quick Answers.

Brief answers on the hospital stay rule.