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Frequently Asked Questions (FAQs)
Newborns' ActI am a pregnant woman. How does the Newborns' Act affect my health care benefits?Who is the attending provider? Under the Newborns' Act, when does the 48-hour (or 96-hour) period start? Under the Newborns' Act, may a group health plan, insurance company, or HMO require me to get permission (sometimes called prior authorization or pre-certification based upon medical necessity) for a 48-hour or 96-hour hospital stay? QUESTION: I am a pregnant woman. How does the Newborns' Act affect my health care benefits? ANSWER: The Newborns' Act affects the amount of time you and your newborn child are covered for a
hospital stay following childbirth. Group health plans, insurance companies, and health
maintenance organizations (HMOs) that are subject to the Newborns' Act may not restrict benefits
for a hospital stay in connection with childbirth to less than 48 hours following a vaginal delivery
or 96 hours following a delivery by cesarean section. However, the attending provider may decide,
after consulting with you, to discharge you or your newborn child earlier. In any case, the
attending provider cannot receive incentives or disincentives to discharge you or your child earlier
than 48 hours (or 96 hours).
QUESTION: Who is the attending provider? ANSWER: An attending provider is an individual licensed under state law who is directly responsible for
providing maternity or pediatric care to a mother or newborn child. Therefore, a plan, hospital,
insurance company, or HMO would not be an attending provider. However, a nurse midwife or a
physician assistant may be an attending provider if licensed in the state to provide maternity or
pediatric care in connection with childbirth.
QUESTION: Under the Newborns' Act, when does the 48-hour (or 96-hour) period start? ANSWER: If you deliver in the hospital, the 48-hour period (or 96-hour period) starts at the time of delivery.
So, for example, if a woman goes into labor and is admitted to the hospital at 10 p.m. on June 11,
but gives birth by vaginal delivery at 6 a.m. on June 12, the 48-hour period begins at 6 a.m. on
June 12.
QUESTION: Under the Newborns' Act, may a group health plan, insurance company, or HMO require me to get permission (sometimes called prior authorization or pre-certification based upon medical necessity) for a 48-hour or 96-hour hospital stay? ANSWER: A plan, insurance company, or HMO cannot deny you or your newborn child coverage for a 48-
hour stay (or 96-hour stay) because the plan claims that you, or your attending provider, have
failed to show that the 48-hour stay (or 96-hour stay) is medically necessary.
However, plans, insurance companies, and HMOs generally can require you to notify the plan of
the pregnancy in advance of an admission if you wish to use certain providers or facilities, or to
reduce your out-of-pocket costs.
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