Employer plans as small as 15 employees are subject to the mandate for maternity and newborn benefits.

Maternity and Newborn Benefit Coverage & Association Health Plans

Protections for Mothers and their Babies

Yes, association health plans provide both maternity and newborn benefits. For large group association health plans, Title VII of the Civil Rights Act requires the plans to cover pregnancy, childbirth, and related conditions in the same manner as they cover other medical conditions under the association health plan. Practically, this means that cost-sharing (e.g. copayments or coinsurance fees) cannot be more expensive than what is charged for health benefits within the insurance plan that are similar in scope to the maternity and newborn benefits.

The maternity and newborn mandate extends beyond large group health plans. The Title VII benefit requirement technically applies to employer plans as small as 15 employees.

With respect to childbirth, The Newborns’ and Mothers’ Health Protection Act of 1996 requires large group association health plans to cover a hospital stay of at least 48 hours for a childbirth and at least 96 hours for a birth by caesarian delivery.

As a form of employer-based health benefits, the coverage of pregnancy and baby care medical services by association health plans is an important dimension of the insurance with respect to its ability to help employers attract and retain quality employees.

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