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Newborn and Mothers Health Protection Act
Group health plans and health insurance issuers generally may not, under
Federal law, restrict benefits for any hospital length of stay in connection with
childbirth for the mother or newborn child to less than 48 hours following a
vaginal delivery, or less than 96 hours following a cesarean section. However,
Federal law generally does not prohibit the mother’s or newborn’s attending
provider, after consulting with the mother, from discharging the mother or her
newborn earlier than 48 hours (or 96 hours as applicable).
In any case, plans and issuers may not, under Federal law, require that a
provider obtain authorization from the plan or the insurance issuer for
prescribing a length of stay not in excess of 48 hours (or 96 hours).
Women’s Health and Cancer Rights Act
If you have had or are going to have a mastectomy, you may be entitled to
certain benefits under the Women’s Health and Cancer Rights Act of 1998
(WHCRA). For individuals receiving mastectomy-related benefits, coverage
will be provided in a manner determined in consultation with the attending
physician and the patient, for:
•
All stages of reconstruction of the breast on which the
mastectomy was performed;
•
Surgery and reconstruction of the other breast to produce a
symmetrical appearance;
•
Prostheses; and
•
Treatment of physical complications of the mastectomy,
including lymphedema.
These benefits will be provided subject to the same deductibles and
coinsurance applicable to other medical and surgical benefits provided under
each plan. If you would like more information on WHCRA benefits, call your
plan administrator at 800-252-8352, extension 2.
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