2005 Idaho Code - 41-3923 — COVERAGE OF ADOPTED NEWBORN CHILDREN -- COVERAGE OF MATERNITY AND COMPLICATIONS OF PREGNANCY

                                  TITLE  41
                                  INSURANCE
                                  CHAPTER 39
                             MANAGED CARE REFORM
    41-3923.  COVERAGE OF ADOPTED NEWBORN CHILDREN -- COVERAGE OF MATERNITY
AND COMPLICATIONS OF PREGNANCY. (1) Any contract delivered or issued for
delivery in this state by an organization offering a managed care plan for
which a certificate of authority is required, which provides coverage for
injury or sickness for newborn dependent children of the members of the
covered group, shall provide such coverage for such newborn children and
infants, including adopted newborn children that are placed with the adoptive
member of the covered group within sixty (60) days of the adopted child's date
of birth, from and after the moment of birth. Coverage under the contract for
an adopted newborn child placed with the adoptive member of the covered group
more than sixty (60) days after the birth of the adopted child shall be from
and after the date the child is so placed. Coverage provided in accord with
this section shall include, but not be limited to, coverage for congenital
anomalies. For the purposes of this section, "child" means an individual who
has not reached eighteen (18) years as of the date of the adoption or
placement for adoption. For the purposes of this section, "placed" shall mean
physical placement in the care of the adoptive member of the covered group, or
in those circumstances in which such physical placement is prevented due to
the medical needs of the child requiring placement in a medical facility, it
shall mean when the adoptive member of the covered group signs an agreement
for adoption of such child and signs an agreement assuming financial
responsibility for such child. Prior to legal finalization of adoption, the
coverage required under the provisions of this subsection (1) as to a child
placed for adoption with a member of the covered group continues in the same
manner as it would with respect to a  naturally born child of the member of
the covered group until the first to occur of the following events:
    (a)  Date the child is removed permanently from that placement and the
    legal obligation terminates; or
    (b)  The date the member of the covered group rescinds, in writing, the
    agreement of adoption or agreement assuming financial responsibility.
    (2)  The managed care organization shall not restrict coverage under a
health care contract of any dependent child adopted by a member, or placed
with a member for adoption, solely on the basis of a preexisting condition of
the child at the time the child would otherwise become eligible for coverage
under the plan, if the adoption or placement for adoption occurs while the
member is  eligible for coverage under the plan.
    (3)  No health care contract which provides maternity benefits for a
person covered continuously from conception shall be issued, amended,
delivered, or renewed in this state if it contains any exclusion, reduction,
or other limitations as to coverage, deductibles, copayments, or coinsurance
provisions as to involuntary complications of pregnancy, unless such
provisions apply generally to all benefits paid under the plan. If a fixed
amount is specified in such plan for surgery, the fixed amounts for surgical
procedures involving involuntary complications of pregnancy shall be
commensurate with other fixed amounts payable for procedures of comparable
difficulty and severity. In a case where a fixed amount is payable for
maternity benefits, involuntary complications of pregnancy shall be deemed an
illness and entitled to benefits otherwise provided by the plan. Where the
plan contains a maternity deductible, the maternity deductible  shall apply
only to expenses resulting from normal delivery and cesarean section delivery;
however, expenses for cesarean section delivery in excess of the deductible
shall be treated as expenses for any other illness under the plan.
    Where a plan which provides or arranges direct health care services for
its members contains a maternity deductible, the maternity deductible shall
apply only to expenses resulting from prenatal care and delivery. However,
expenses resulting from any delivery in excess of the deductible amount shall
be treated as expenses for any other illness under the plan. If the pregnancy
is interrupted, the maternity deductible charged for prenatal care and
delivery shall be based on the value of the medical services received,
providing that it is never more than two-thirds (2/3) of the plan's maternity
deductible.
    This section shall apply to all health care contracts except any group
health care contracts made subject to an applicable collective-bargaining
agreement in effect before January 1, 1977.
    For purposes of this section, involuntary complications of pregnancy shall
include, but not be limited to, puerperal infection, eclampsia, cesarean
section delivery, ectopic pregnancy, and toxemia.
    All health care contracts subject to this section and issued, amended,
delivered, or renewed in this state on or after January 1, 1977, shall be
construed to be in compliance with this section, and any provision in any such
plan which is in conflict with this section shall be of no force or effect.
    (4)  From and after January 1, 1998, no policy of disability insurance
which provides medical expense maternity benefits shall restrict benefits for
any hospital length of stay in connection with childbirth for the mother or
newborn child in a manner that would be in conflict with the newborns' and
mothers' health protection act of 1996.