96 General Benefit Provisions Statement Regarding Newborns and Mothers Health Protection Act The Plan will pay benefits for Pregnancy on the same basis as an illness or injury. Under federal law, group health plans may not restrict benefits for any Hospital stay in connection with chil dbirth for the mother or newborn child to less than 48 hours following vaginal delivery, or less than 96 hours following a delivery by cesarean section. However, the Plan may pay for a shorter stay if the attending provider (e.g., physician, nurse midwife, or physician assistant), after consultation with the mother, discharges the mother or newborn earlier. Also, under federal law, plans may not set the level of benefits or out - of - pocket costs so that any later portion of the 48 - hour (or 96 - hour) stay is tr eated in a manner less favorable to the mother or newborn than a ny earlier portion of the stay. In addition, the Plan may not, under federal law, require that a physician or other health care provider obtain authorization for prescribing a length of stay o f up to 48 hours (or 96 hours). However, to use certain providers or facilities, or to reduce your out - of - pocket costs, you may be require d to obtain precertification. Statement Regarding Women’s Health and Cancer Act In the case of any participant receiv ing benefits under the Plan in connection with a mastectomy and who elects breast reconstruction, coverage will be provided under the Plan for: • Reconstruction of the breast on which the mastectomy was performed; • Surgery and reconstruction of the other brea st to produce a symmetrical appear ance; and • Prostheses and treatment of physical complications at all stages of the mastectomy, including lymphedemas. As with other benefits under the Plan, applicable deductibles and cost sharing amoun ts apply to the above coverage.
2018 BTF Plan B Page 100 Page 102