CurrentNorth Dakota Insurance DepartmentPolicy 99-3

48/96 Hour Maternity Mandate

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Applies to North Dakota individual and group health insurance policies providing maternity benefits; limited benefit policies are excluded.

Policy Summary

PayerNorth Dakota Insurance Department

Policy48/96 Hour Maternity Mandate

Policy CodePolicy 99-3

Change TypeNo material change

Effective DateNovember 12, 1999

Next Review DateN/A

Key ActionWhen maternity coverage is provided, cover 48 hours after a normal vaginal delivery and 96 hours after an uncomplicated C-section.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

48 hoursNormal vaginal delivery

96 hoursUncomplicated C-section

Individual and groupMarkets covered

Aug 1, 1997Compliance date

NoneAdditional maternity deductible

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CurrentNorth Dakota Insurance DepartmentPolicy 99-3

48/96 Hour Maternity Mandate

Customize your policy alerts

Sign up for North Dakota Insurance Department Policy 99-3 alerts

Get alerted when Policy 99-3 changes without checking for updates manually.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Applies to North Dakota individual and group health insurance policies providing maternity benefits; limited benefit policies are excluded.

Policy Summary

PayerNorth Dakota Insurance Department

Policy48/96 Hour Maternity Mandate

Policy CodePolicy 99-3

Change TypeNo material change

Effective DateNovember 12, 1999

Next Review DateN/A

Key ActionWhen maternity coverage is provided, cover 48 hours after a normal vaginal delivery and 96 hours after an uncomplicated C-section.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

48 hoursNormal vaginal delivery

96 hoursUncomplicated C-section

Individual and groupMarkets covered

Aug 1, 1997Compliance date

NoneAdditional maternity deductible

Maternity Coverage Requirements

Required maternity hospitalization period

Covered when maternity coverage is provided under the policy or certificate.

Delivery type

Normal vaginal delivery: The delivery is a normal vaginal delivery.48 hours
Coverage period required.
Uncomplicated C-section: The delivery is an uncomplicated C-section.96 hours
Coverage period required.

Maternity cost-sharing requirements

Maternity benefits must receive the same type of cost sharing as other hospitalizations.

Cost-sharing parity: Any deductible, coinsurance, or other cost-sharing mechanism applied to maternity hospitalization must be the same type and applied on the same basis as for other hospitalizations.

No additional or separate maternity deductible, different cost-sharing mechanism, or graded coinsurance may be applied.

Maternity benefit caps

Maternity coverage caps are permitted only under specified conditions.

Permitted maternity cap: A maternity cap may be used only if caps are also applied to other benefits, the maternity cap is not unreasonably low, and it provides at least the cost of the required maternity hospitalization period.At least the cost of the 48/96-hour maternity period

The applicable maternity period depends on delivery type.

Dependent maternity coverage

Dependent maternity hospitalization must be covered when dependent coverage is provided for other services.

Dependent coverage parity: If dependent coverage is provided for any other services under the policy or certificate, dependent maternity hospitalization must also be covered under the mandated maternity coverage terms.

Dependent pregnancies may not be excluded when dependent coverage is otherwise provided.

The maternity mandate requirements do not apply to a limited benefit policy. The bulletin otherwise applies to individual and group health insurance issued by insurers authorized to sell coverage in North Dakota.

Compliance and Coverage Risks

Billing Rule

Limited Benefit Policy Exclusion

Do not apply the 48/96-hour maternity mandate to a limited benefit policy. Confirm the policy type before requiring or adjudicating maternity coverage under this mandate.

The requirements do not apply to a limited benefit policy.

Denial Risk

Insufficient Maternity Benefit Cap

Review any maternity benefit cap for compliance before applying it. A cap is permissible only when caps also apply to other benefits, is not unreasonably low, and covers at least the cost of the required 48/96-hour maternity hospitalization period.

Caps must apply to other benefits as well.

Policy Purpose and Scope

This bulletin establishes minimum maternity hospitalization coverage when maternity benefits are included in a policy or certificate. It distinguishes required coverage periods for normal vaginal delivery and uncomplicated cesarean delivery and addresses related protections, including nondiscriminatory cost sharing, permitted benefit caps, and dependent maternity coverage. Future individual and group health filings must comply, and conflicting provisions in existing policies or certificates must be interpreted to comply effective August 1, 1997.