Pregnancy
Care – 90%
Mother
Benefits are provided for
services and supplies for pregnancy-related conditions for the female
participant or male participant’s spouse only. Covered pregnancy-related
conditions include normal delivery, cesarean section, spontaneous abortion
(miscarriage), legal abortion, and complications of pregnancy.
Covered
services and supplies include:
- Outpatient
and inpatient hospital prenatal and postnatal
care.
- Prenatal
diagnosis of congenital disorders of the fetus by means of screening and
diagnostic procedures during pregnancy, when medically necessary.
- Childbirth
in an approved birthing center that is licensed as required by the state in
which it operates.
Pregnancy
care by a physician or certified nurse midwife is covered under this benefit. A
licensed midwife may also be covered but certain restrictions apply.
Contact the
Trust Office for preauthorization.
Pursuant
to federal law, the plan provides that no hospital stay in connection with
childbirth, either for the mother or for the newborn child, may be limited to
less than 48 hours following a vaginal delivery or less than 96 hours following
a cesarean section, unless there is an agreement between the mother and the
attending physician that the length of stay shall be less than the above
periods. The plan will not provide coverage, or may apply the preadmission
certification penalty, if the mother or newborn remains in the facility more
than the minimum length of stay (as described above) without prior approval from
the medical review agency.
Benefits
are not
provided for:
- Postpartum
home help or visits.
- A
dependent daughter’s pregnancy or resulting childbirth, miscarriage or
abortion including complications thereof, unless required by law.
Newborn
Care
Benefits are provided for
services and supplies for routine newborn care for a dependent child during the
child’s initial confinement at birth. The newborn must satisfy his or her
annual deductible and coinsurance requirements. Eligibility and
enrollment requirements are described in
Enrolling for Coverage.
Covered services and supplies
include:
- Routine
hospital services and supplies while the mother is in the hospital.
- Physician
services.
- Circumcision
during the initial hospitalization or in the physician’s office
thereafter.
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