Pregnancy
Care – 90%
Mother
Benefits are
provided for services and supplies for pregnancy-related conditions for the
female retiree or male retiree’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 pread-mission
certification penalty, if the mother or newborn remains in the facility longer
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 on page
16. 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, if
eligible.
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