Section 17C: Required coverage for abortion, abortion-related care, prenatal care, childbirth, and postpartum care
[First paragraph applicable as provided by 2022, 127, Sec. 44.]
Section 17C. The commission shall provide to any active or retired employee of the commonwealth who is insured under the group insurance commission coverage for abortion as defined in section 12K of chapter 112, abortion-related care, prenatal care, childbirth and postpartum care, with a minimum of forty-eight hours of in-patient care following a vaginal delivery and a minimum of ninety-six hours of in-patient care following a caesarean section for a mother and her newly born child. Any decision to shorten these minimum coverages shall be made by the attending physician in consultation with the mother. Any such decision shall be made in accordance with rules and regulations promulgated by the department of public health. Said regulations shall be relative to early discharge, defined as less than forty-eight hours for a vaginal delivery and ninety-six hours for a caesarean delivery and post-delivery care and shall include, but not be limited to, home visits, parent education, assistance and training in breast or bottle feeding and the performance of any necessary and appropriate clinical tests; provided, however, that the first home visit shall be conducted by a registered nurse, physician, or certified nurse midwife; and provided, further, that any subsequent home visit determined to be clinically necessary shall be provided by a licensed health care provider.
For the purposes of this section, attending physician shall include the attending obstetrician, pediatrician, or certified nurse midwife attending the mother and newly born child.
[Third and fourth paragraphs applicable as provided by 2022, 127, Sec. 44.]
Coverage provided under this section for abortion or abortion-related care shall not be subject to any deductible, coinsurance, copayment or any other cost-sharing requirement; provided, however, that deductibles, coinsurance or copayments shall be required if the applicable plan is governed by the federal Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on deductibles, coinsurance or copayments for these services. Coverage for abortion or abortion-related care offered under this section shall not impose unreasonable restrictions or delays in the coverage.
Benefits for an enrollee under this section shall be the same for the enrollee's covered spouse and covered dependents.
Any subscriber or member who is aggrieved by a denial of benefits to be provided under this section may appeal said denial in accordance with regulations of the department of public health.