To amend title XXVII of the Public Health Service Act to limit cost sharing for prenatal services in certain circumstances.
Analysis under review: This bill has generated analysis that may be too generic or incomplete. Clause-level evidence remains available below.
Summary
What This Bill Does
The Caring for Grieving Families Act addresses a financial burden faced by families who experience miscarriage or stillbirth. Currently, many health insurance plans structure maternity care as a "bundled payment" - meaning prenatal care (ultrasounds, doctor visits, etc.) is only fully covered when the pregnancy results in a live birth. If a pregnancy ends in miscarriage or stillbirth, families can be stuck with full out-of-pocket costs for all prenatal services. This bill ensures that when pregnancy loss occurs, the cost-sharing (deductibles, copays, coinsurance) for prenatal care cannot exceed what it would have been if the pregnancy had resulted in a birth.
Who Benefits and How
Individuals and families who experience miscarriage or stillbirth benefit directly by avoiding potentially thousands of dollars in unexpected medical bills for prenatal care they already received. Instead of being charged full price for prenatal services when the bundled payment doesn't trigger, they pay only the cost-sharing amount that would have applied to the full maternity bundle (often much lower). Healthcare providers may also see indirect benefits through improved payment rates for prenatal services rendered to patients who experience pregnancy loss.
Who Bears the Burden and How
Health insurance companies and employer-sponsored health plans bear the primary burden. They must absorb the cost difference between full prenatal service charges and the lower cost-sharing amounts they can now collect from patients who experience pregnancy loss. This represents a decrease in revenue from cost-sharing and an increase in claims costs. Insurers and plan administrators will also face new compliance requirements to restructure their billing and payment systems to track and apply these protections.
Key Provisions
- Applies to any group health plan or individual/group health insurance coverage that uses bundled payments for maternity care
- Prohibits charging patients more in cost-sharing for prenatal services after miscarriage/stillbirth than they would have paid under the bundled payment structure
- Covers all prenatal services included in the bundled payment, such as imaging tests and office visits
- Takes effect for plan years beginning on or after January 1, 2027
- Amends the Public Health Service Act to create permanent consumer protections in this area
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers.
At a Glance
What This Bill Does
Eliminates cost-sharing requirements for prenatal services when a pregnancy ends in miscarriage or stillbirth under bundled payment health plans.
Who Benefits
- Individuals who experience miscarriage or stillbirth
- Families with pregnancy loss
Who Bears Costs
- Health insurance companies
- Group health plans
- Self-insured employer health plans
Key Policy Areas
Healthcare, Insurance Regulation, Maternal Health
Primary Purpose
Eliminates cost-sharing requirements for prenatal services when a pregnancy ends in miscarriage or stillbirth under bundled payment health plans.
Policy Domains
Legislative Strategy
"Address financial burden on families experiencing pregnancy loss by ensuring prenatal care costs are covered at the same rate as if the pregnancy had resulted in a live birth"
Identified Gains
- Individuals who experience miscarriage or stillbirth
- Families with pregnancy loss
Identified Costs
- Health insurance companies
- Group health plans
- Self-insured employer health plans
Sponsors
Legislative Progress
IntroducedMr. Vindman (for himself and Mrs. Miller-Meeks) introduced the following …
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Health insurance carriers with bundled maternity payment structures, Health insurance companies offering group and individual coverage with bundled maternity payments
Group health plans offering bundled maternity benefits, Self-insured employer group health plans with bundled maternity benefits
Individuals who experience miscarriage or stillbirth, Pregnant individuals who subsequently experience pregnancy loss
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "plan_or_coverage"
- → Group health plan or group/individual health insurance coverage
Key Definitions
Terms defined in this bill
Deductibles, coinsurance, and copayments imposed on covered services
A payment arrangement where items and services furnished to an individual relating to the birth of a child are paid as a single package, including prenatal services such as imaging tests and office visits
Items and services furnished prior to birth, including imaging tests and office visits
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology