Section 1373.4 Of Article 5. Standards From California Health And Safety Code >> Division 2. >> Chapter 2.2. >> Article 5.
1373.4
. (a) No health care service plan contract that is issued,
amended, renewed, or delivered on or after July 1, 2003, that
provides maternity coverage shall do either of the following:
(1) Contain a copayment or deductible for inpatient hospital
maternity services that exceeds the most common amount of the
copayment or deductible contained in the contract for inpatient
services provided for other covered medical conditions.
(2) Contain a copayment or deductible for ambulatory care
maternity services that exceeds the most common amount of the
copayment or deductible contained in the contract for ambulatory care
services provided for other covered medical conditions.
(b) No health care service plan that 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, or coinsurance provisions as to involuntary
complications of pregnancy, unless the provisions apply generally to
all benefits paid under the plan.
(c) 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 it is never more than
two-thirds of the plan's maternity deductible.
(d) 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.
(e) This section shall not permit copayments or deductibles in the
Medi-Cal program that are not otherwise authorized under state or
federal law.
(f) This section shall become operative on July 1, 2003.