2024 Texas Statutes
Insurance Code
Title 8 - Health Insurance and Other Health Coverages
Subtitle E - Benefits Payable Under Health Coverages
Chapter 1366 - Benefits Related to Fertility and Childbirth
Subchapter B. Minimum Inpatient Stay Following Birth of Child and Postdelivery Care
Section 1366.055. Coverage for Inpatient Care Required
Sec. 1366.055. COVERAGE FOR INPATIENT CARE REQUIRED. (a) Except as provided by Subsection (b), a health benefit plan that provides maternity benefits, including benefits for childbirth, must provide to a woman who has given birth to a child and the newborn child coverage for inpatient care in a health care facility for not less than:
(1) 48 hours after an uncomplicated vaginal delivery; and
(2) 96 hours after an uncomplicated delivery by cesarean section.
(b) A health benefit plan that provides to a woman who has given birth to a child and the newborn child coverage for in-home postdelivery care is not required to provide the coverage required under Subsection (a) unless:
(1) the attending physician determines that inpatient care is medically necessary; or
(2) the woman requests inpatient care.
(c) For purposes of Subsection (a), the attending physician shall determine whether a delivery is complicated.
(d) This section does not require a woman who is eligible for coverage under a health benefit plan to:
(1) give birth to a child in a hospital or other health care facility; or
(2) remain under inpatient care in a hospital or other health care facility for any fixed term following the birth of a child.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
