Sponsors (4)
Requires comprehensive maternity/newborn care and one-year postpartum coverage and bans cost-sharing for those services across ACA marketplace, ERISA, and IRC-covered plans.
The bill significantly expands and standardizes maternal, neonatal, and postpartum benefits—reducing out‑of‑pocket costs and improving access and predictability for new parents—while trading off higher costs for insurers and employers that may raise premiums, prompt network or benefit restrictions, increase administrative burdens, and create potential fiscal and implementation challenges.
Pregnant and postpartum people will receive comprehensive prenatal through one-year postpartum care (including prenatal, childbirth, neonatal, perinatal, and postpartum services) with no cost‑sharing beginning in the first plan year after enactment, reducing direct financial barriers to recommended care.
New parents—both birthing and non‑birthing legal parents—gain expanded behavioral health coverage for pregnancy‑exacerbated or pregnancy‑caused conditions and access to postpartum behavioral health services for up to one year, improving support for mental and physical health after birth.
People experiencing miscarriage or spontaneous pregnancy loss receive explicit coverage for related care, reducing out‑of‑pocket costs and financial burden during pregnancy loss.
Insured individuals and families face the risk of higher premiums or other cost increases because health plans and employers may incur higher expenses from the expanded mandated benefits.
Employers and ERISA‑governed plans will face increased benefit and administrative costs to comply with new coverage requirements, creating burdens for small businesses and plan administrators.
Insurers may try to control added costs by narrowing provider networks, imposing more prior authorization requirements, or scaling back other covered benefits, which could reduce enrollees' access to preferred providers and services.
Based on analysis of 3 sections of legislative text.
Official title: Prevent cost-sharing requirements for prenatal, childbirth, neonatal, perinatal, or postpartum health care.
Introduced May 21, 2025 by Cindy Hyde-Smith · Last progress May 21, 2025
Requires health plans to cover a comprehensive set of maternity, newborn, perinatal, and postpartum services (defined to include prenatal care, delivery, neonatal care, miscarriage care, anesthesia, fetal monitoring, specialist consults, and behavioral health) and makes those benefits free of cost-sharing. It extends the postpartum period to one year after pregnancy and requires coverage for behavioral health for pregnancy-exacerbated or pregnancy-caused conditions and for non-birthing legal parents for one year. Applies these coverage and no-cost-sharing requirements across the ACA marketplaces, group plans governed by ERISA, and the Internal Revenue Code’s group plan rules for plan years beginning on or after the Act’s enactment; the bill also directs that these provisions be treated as if part of the original ACA enactment for interpretive purposes.