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Title 29 — LaborRelease 119-73

§1185 Standards relating to benefits for mothers and newborns

Title 29 › Chapter CHAPTER 18— - EMPLOYEE RETIREMENT INCOME SECURITY PROGRAM › Subchapter SUBCHAPTER I— - PROTECTION OF EMPLOYEE BENEFIT RIGHTS › Subtitle Subtitle B— - Regulatory Provisions › Part part 7— - group health plan requirements › Subpart Subpart B— - Other Requirements › § 1185

Last updated Apr 6, 2026|Official source

Summary

Require group health plans and group health insurers to cover hospital stays after childbirth of at least 48 hours for a normal vaginal birth and at least 96 hours for a cesarean. Plans may not make a doctor get prior approval to order those lengths of stay. A shorter stay is allowed if the attending provider and the mother agree to discharge earlier. Mothers are not forced to give birth in a hospital or to stay any fixed time. Plans also may not drop or refuse to enroll someone just to avoid these rules, pay mothers to leave early, punish or pay doctors to limit care, or make later days of a required stay have worse benefits than earlier days. Plans can still charge deductibles or coinsurance, but any cost-sharing during the required stay cannot increase for later portions of that stay. Plans must notify participants about this change and provide the required summary no later than 60 days after the first day of the plan year when the rule starts. If a State already has equal or stronger rules (including 48/96, professional guidelines, or leaving the decision to the provider and mother), the State law applies instead.

Full Legal Text

Title 29, §1185

Labor — Source: USLM XML via OLRC

(a)(1)A group health plan, and a health insurance issuer offering group health insurance coverage, may not—
(A)except as provided in paragraph (2)—
(i)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 48 hours, or
(ii)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 96 hours; or
(B)require that a provider obtain authorization from the plan or the issuer for prescribing any length of stay required under subparagraph (A) (without regard to paragraph (2)).
(2)Paragraph (1)(A) shall not apply in connection with any group health plan or health insurance issuer in any case in which the decision to discharge the mother or her newborn child prior to the expiration of the minimum length of stay otherwise required under paragraph (1)(A) is made by an attending provider in consultation with the mother.
(b)A group health plan, and a health insurance issuer offering group health insurance coverage in connection with a group health plan, may not—
(1)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;
(2)provide monetary payments or rebates to mothers to encourage such mothers to accept less than the minimum protections available under this section;
(3)penalize or otherwise reduce or limit the reimbursement of an attending provider because such provider provided care to an individual participant or beneficiary in accordance with this section;
(4)provide incentives (monetary or otherwise) to an attending provider to induce such provider to provide care to an individual participant or beneficiary in a manner inconsistent with this section; or
(5)subject to subsection (c)(3), restrict benefits for any portion of a period within a hospital length of stay required under subsection (a) in a manner which is less favorable than the benefits provided for any preceding portion of such stay.
(c)(1)Nothing in this section shall be construed to require a mother who is a participant or beneficiary—
(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.
(2)This section shall not apply with respect to any group health plan, or any group 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.
(3)Nothing in this section shall be construed as preventing a group health plan or 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 the plan (or under health insurance coverage offered in connection with a group health plan), except that such coinsurance or other cost-sharing for any portion of a period within a hospital length of stay required under subsection (a) may not be greater than such coinsurance or cost-sharing for any preceding portion of such stay.
(d)The imposition of the requirements of this section shall be treated as a material modification in the terms of the plan described in section 1022(a)(1) 11 See References in Text note below. of this title, for purposes of assuring notice of such requirements under the plan; except that the summary description required to be provided under the last sentence of section 1024(b)(1) of this title with respect to such modification shall be provided by not later than 60 days after the first day of the first plan year in which such requirements apply.
(e)Nothing in this section shall be construed to prevent a group health plan or a health insurance issuer offering group health insurance coverage from negotiating the level and type of reimbursement with a provider for care provided in accordance with this section.
(f)(1)The requirements of this section shall not apply with respect to health insurance coverage if there is a State law (as defined in section 1191(d)(1) of this title) for a State that regulates such coverage that is described in any of the following subparagraphs:
(A)Such State law requires such coverage to provide for at least a 48-hour hospital length of stay following a normal vaginal delivery and at least a 96-hour hospital length of stay following a cesarean section.
(B)Such State law requires such coverage to provide for maternity and pediatric care in accordance with guidelines established by the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, or other established professional medical associations.
(C)Such State law requires, in connection with such coverage for maternity care, that the hospital length of stay for such care is left to the decision of (or required to be made by) the attending provider in consultation with the mother.
(2)section 1191(a)(1) of this title shall not be construed as superseding a State law described in paragraph (1).

Legislative History

Notes & Related Subsidiaries

Editorial Notes

References in Text

section 1022(a)(1) of this title, referred to in subsec. (d), was redesignated section 1022(a) of this title by Pub. L. 105–34, title XV, § 1503(b)(1)(B), Aug. 5, 1997, 111 Stat. 1061.

Statutory Notes and Related Subsidiaries

Effective Date

Section applicable with respect to group health plans for plan years beginning on and after Jan. 1, 1998, see section 603(c) of Pub. L. 104–204, set out as an

Effective Date

of 1996 Amendment note under section 1003 of this title.

Reference

Citations & Metadata

Citation

29 U.S.C. § 1185

Title 29 — Labor

Last Updated

Apr 6, 2026

Release point: 119-73