20-2321

20-2321. Maternity benefits; adoption;
coverage

A. A contract that is issued to an enrollee pursuant to this article and that
provides coverage for maternity benefits shall also provide that the maternity benefits
apply to the costs of the birth of a child who is legally adopted by the enrollee if all
of the following are true:

1. The child is adopted within one year of birth.

2. The enrollee is legally obligated to pay the costs of birth.

3. All preexisting conditions and other limitations have been met and all
deductibles and copayments have been paid by the enrollee.

4. The enrollee has notified the insurer of the enrollee's acceptability to adopt
children pursuant to section 8-105 within sixty days after this approval or within sixty
days after a change in insurance policies, plans or companies.

B. The coverage prescribed by subsection A of this section is excess to any other
coverage the natural mother may have for maternity benefits except coverage made
available to persons pursuant to title 36, chapter 29 but not including coverage made
available to persons defined as eligible under section 36-2901, paragraph 6, subdivisions
(b), (c), (d) and (e).

C. If other coverage exists the agency, attorney or individual arranging the
adoption shall make arrangements for the insurance to pay those costs that may be covered
under that policy and shall advise the adopting parent in writing of the existence and
extent of the coverage without disclosing any confidential information such as the
identity of the natural parent.

D. The enrollee adopting parents shall notify their accountable health plan of the
existence and extent of the other coverage.

E. An accountable health plan is not required to pay any costs in excess of the
amounts it would have been obligated to pay to its hospitals and providers if the natural
mother and child had received the maternity and newborn care directly from or through
that accountable health plan.

F. Beginning January 1, 1998, any contract that provides maternity benefits shall
not restrict benefits for any hospital length of stay in connection with childbirth for
the mother or the newborn child to less than forty-eight hours following a normal vaginal
delivery or ninety-six hours following a cesarean section. The contract shall not
require the provider to obtain authorization from the accountable health plan for
prescribing the minimum length of stay required by this subsection. The contract may
provide that an attending provider in consultation with the mother may discharge the
mother or the newborn child before the expiration of the minimum length of stay required
by this subsection. The accountable health plan shall not:

1. Deny the mother or the newborn child eligibility or continued eligibility to
enroll or to renew coverage under the terms of the contract solely for the purpose of
avoiding the requirements of this subsection.

2. Provide monetary payments or rebates to mothers to encourage those mothers to
accept less than the minimum protections available pursuant to this subsection.

3. Penalize or otherwise reduce or limit the reimbursement of an attending provider
because that provider provided care to any insured under the contract in accordance with
this subsection.

4. Provide monetary or other incentives to an attending provider to induce that
provider to provide care to an insured under the contract in a manner that is
inconsistent with this subsection.

5. Except as described in subsection G of this section, restrict benefits for any
portion of a period within the minimum length of stay in a manner that is less favorable
than the benefits provided for any preceding portion of that stay.

G. Nothing in subsection F of this section:

1. Requires a mother to give birth in a hospital or to stay in the hospital for a
fixed period of time following the birth of the child.

2. Prevents an accountable health plan from imposing deductibles, coinsurance or
other cost sharing in relation to benefits for hospital lengths of stay in connection
with childbirth for a mother or a newborn child under the contract, except that any
coinsurance or other cost sharing for any portion of a period within a hospital length of
stay required pursuant to subsection F of this section shall not be greater than the
coinsurance or cost sharing for any preceding portion of that stay.

3. Prevents an accountable health plan from negotiating the level and type of
reimbursement with a provider for care provided in accordance with subsection F of this
section.

H. An accountable health plan shall not impose any preexisting condition exclusions
or limitations relating to pregnancy as a preexisting condition.