Section 4I: Abortion, abortion-related care, prenatal care, childbirth and postpartum care benefits; minimum coverage for in-patient care; exemptions
[ Text of section applicable as provided by 2022, 127, Sec. 44.]
Section 4I. Any health maintenance contract shall provide coverage for abortion, as defined in section 12K of chapter 112, abortion-related care, prenatal care, childbirth and postpartum care in accordance with section four of chapter one hundred and seventy-six G. In addition to such benefits, such health maintenance contract shall provide coverage of 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 through fifth 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 offered under this section for abortion or abortion-related care 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.
A health maintenance contract that is purchased by an employer that is a church or qualified church-controlled organization, as those terms are defined in subsection (j) of section 4O, shall be exempt from covering abortion or abortion-related care at the request of the employer. An employer that invokes the exemption under this subsection shall provide written notice to prospective enrollees prior to enrollment with the plan and such notice shall list the health care methods and services for which the employer will not provide coverage for religious reasons.
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.