Senate Bill NO. 2565

By Representative(s) Committee

SECTION 1. The following section shall be codified in Chapter 9 of Title 83, Mississippi Code of 1972:

(1) As used in this section, the term "health insurance issuer" means any insurance company, hospital or medical service plan or any entity defined in Section 83-41-303(n), which offers group or individual health insurance coverage in the State of Mississippi.

(2) A health insurance issuer shall not, except as provided in subsection (3) of this section:

(a) Restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child following a normal vaginal delivery to less than forty-eight (48) hours; or

(b) Restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child following a Cesarean section to less than ninety-six (96) hours; or

(c) Require that a provider obtain authorization from the health insurance issuer for prescribing any length of stay required in this subsection (2).

(3) This section shall not apply in connection with any health insurance issuer in any case in which the decision to discharge the mother or her newborn child before the expiration of the minimum length of stay otherwise required under subsection (2) of this section is made by an attending provider in consultation with the mother.

(4) A health insurance issuer offering group or individual health insurance coverage in connection with a group or individual health plan, shall not:

(a) Deny to the mother or her newborn child eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the plan solely for the purpose of avoiding the requirements of this section;

(b) Provide monetary payments or rebates to mothers to encourage such mothers to accept less than the minimum protections available under this section;

(c) Penalize or otherwise reduce or limit the reimbursement of an attending provider because such provider provided care to an insured or enrollee in accordance with this section;

(d) Provide incentives, monetary or otherwise, to an attending provider to induce such provider to provide care to an insured or enrollee in a manner inconsistent with this section; or

(e) Subject to subsection (7) of this section, restrict benefits for any portion of a period within a hospital length of stay required under subsection (2) of this section in a manner which is less favorable than the benefits provided for any preceding portion of such stay.

(5) Nothing in this section shall be construed to require a mother who is an insured or enrollee:

(a) To give birth in a hospital; or

(b) To stay in the hospital for a fixed period of time following the birth of her child.

(6) This section shall not apply with respect to any group or individual 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.

(7) Nothing in this section shall be construed as preventing a health insurance issuer 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 newborn child under group or individual health insurance coverage, except that such coinsurance or other cost-sharing for any portion of a period within a hospital length of stay required under subsection (2) of this section may not be greater than such coinsurance or cost-sharing for any preceding portion of such stay.

(8) A health insurance issuer providing health insurance coverage in connection with a group or individual health plan shall provide notice to the named insured in the case of an individual policy, and to each certificate holder in the case of a group policy, regarding the coverage required by this section. Such notice shall be in writing and prominently positioned in any literature or correspondence made available or distributed by the health insurance issuer and shall be transmitted to the named insured or certificate holder not later than July 1, 2000. The notice prescribed by this subsection shall be filed with and approved by the Commissioner of Insurance before distribution by the health insurance issuer.

(9) Nothing in this section shall be construed to prevent a health insurance issuer offering group or individual health insurance coverage from negotiating the level and type of reimbursement with a provider for care provided in accordance with this section.

SECTION 2. This act shall take effect and be in force from and after its passage.

AN ACT TO PROVIDE HEALTH INSURANCE REQUIREMENTS FOR MINIMUM HOSPITAL STAY BENEFITS FOLLOWING CHILDBIRTH; TO PROVIDE EXCEPTIONS; TO REQUIRE HEALTH INSURANCE ISSUERS TO PROVIDE NOTICE REGARDING THE REQUIRED COVERAGE; AND FOR RELATED PURPOSES.