Title 33, Chapter 24, Section 24
( 33-24-24)
(a) For the purposes of this Code section, the term: (1) "Complications of pregnancy" means the following: (A) Conditions requiring hospital confinement when the pregnancy
is not terminated and whose diagnoses are distinct from
pregnancy but are adversely affected by pregnancy or are caused
by pregnancy, such as acute nephritis, nephrosis, cardiac
decompensation, missed abortion, pre-eclampsia, intrauterine
fetal growth retardation, and similar medical and surgical
conditions of comparable severity; but the term shall not
include false labor, occasional spotting, physician prescribed
rest during the period of pregnancy, morning sickness,
hyperemesis gravidarum, and similar conditions associated with
the management of a difficult pregnancy not constituting a
nosologically distinct complication of pregnancy; and (B) Ectopic pregnancy which is terminated. (2) "Group policy or group contract" means a group or blanket
accident and sickness insurance policy or contract as defined in
Chapter 30 of this title, a group contract of the type issued by a
hospital service nonprofit corporation established under Chapter
19 of this title, a group contract of the type issued by a health
care plan established under Chapter 20 of this title, a group
contract of the type issued by a nonprofit medical service
corporation established under Chapter 18 of this title, or any
similar group benefit plan, policy, or contract. (3) "Major medical coverage" means coverage which provides
benefits of at least 75 percent of necessary, reasonable, and
customary charges for medical care, including hospitalization in
semiprivate accommodations, with maximum lifetime benefits of at
least $100,000.00. (b) Each group policy or group contract issued, delivered, issued
for delivery, amended, or renewed in this state after January 1,
1978, which provides major medical coverage and which includes
maternity benefits shall include complications of pregnancy within
such major medical coverage for all persons who have been covered by
the policy or contract for a period of nine months or for a period
of at least 30 days immediately prior to the date conception occurs
or pregnancy commences. The same coverage for complications of
pregnancy shall be provided for all family members and dependents
with major medical coverage under the group policy or group
contract. (c) Group policies or group contracts subject to this Code section
shall not contain any exclusions, reductions, or other limitations
as to coverages, deductibles, or coinsurance provisions which apply
to complications of pregnancy unless the provisions apply generally
to all benefits provided or paid for under the group policies or
group contracts. (d) If fixed amounts for surgery are specified in any group policy
or group contract subject to this Code section, the fixed amounts
for surgical procedures involving complications of pregnancy shall
be commensurate with other fixed amounts payable for procedures of
comparable difficulty and severity. (e) If any group policy or group contract subject to this Code
section provides a fixed amount for maternity benefits,
complications of pregnancy shall be treated the same as an illness
rather than pregnancy and a person covered by the group policy or
group contract shall be entitled to benefits otherwise provided by
the group policy or group contract. (f) Nothing contained in this Code section shall be deemed to
prohibit an insurer or nonprofit corporation from issuing group
policies or group contracts which contain provisions providing
benefits greater than the minimum benefits required by this Code
section or from issuing group policies or group contracts which
contain provisions which are generally more favorable to the insured
than those required by this Code section. |