Maternity Care. Obstetrical care received both before and after the delivery of a child or children. It includes regular nursery care for a newborn infant as long as the mother’s Hospital stay is a covered benefit and the newborn infant is an eligible Member under the Contract. Maximum Allowed Cost or Maximum Allowable Charge (MAC) Maximum Allowed Cost and/or Maximum Allowable Charge shall mean the maximum amount payable for a Covered Service under the Contract and meeting Medical Necessity and Prior Authorization requirements. The MAC will not include any identifiable billing mistakes including, but not limited to, up-coding, unbundled services/charges, duplicate charges, and charges for services not performed. Medical Child Support Order (MCSO) An MCSO is any court judgment, decree or order (including a court’s approval of a domestic relations settlement agreement) that: • Provides for child support payment related to health benefits with respect to the child of a health plan participant or requires health benefit coverage of such child in such plan, and is ordered under state domestic relations law; or • Enforces a state law relating to medical child support payment with respect to a health plan. Medical Facility Any Hospital, ambulatory care facility, Chemical Dependency Treatment Facility, Skilled Nursing facility, Home Health Care Agency or mental health facility, as defined in this Certificate. The facility must be licensed, registered or approved by the Joint Commission on Accreditation of Hospitals or meet specific requirements established by Us. Medical Necessity or Medically Necessary We reserve the right to determine whether a health care service or supply is Medically Necessary. The fact that a Physician has prescribed, ordered, recommended or approved a service or supply does not, in itself, make it Medically Necessary. We consider a health care service Medically Necessary if it is: • Appropriate and consistent with the diagnosis and the omission of which could adversely affect or fail to improve the patient’s condition; • Compatible with the standards of acceptable medical practice in the United States; • Not provided solely for Your convenience or the convenience of the doctor, health care Provider or Hospital; • Not primarily Custodial Care; and • Provided in a safe and appropriate setting given the nature of the diagnosis and the severity of the symptoms. For example, a Hospital stay is necessary when treatment cannot be safely provided on an outpatient ...
Maternity Care. We pregnancies and associated maternity care the same way We would cover an Illness. Maternity care includes medically necessary prenatal and postpartum visits, laboratory and imaging services. [We also cover Doula care.]
Maternity Care. (Except plans C Plus, D and E):
Maternity Care. (Except plans IV, V and VI):
Maternity Care. The Contractor shall provide or arrange to provide quality care for pregnant Enrollees. At a minimum, the Contractor shall provide, or arrange to provide, and document:
Maternity Care. Care and treatment related to conception, delivery, and abortion, including prenatal and post- natal care (generally through the 6th post-delivery week), and also including treatment of the complications of preg- xxxxx.
Maternity Care. When a woman has entered prenatal care before enrolling with the Contractor shall take every effort to allow her to continue with the same prenatal care provider throughout the entire pregnancy. Contractor shall also establish procedures to assure either prompt initiation of prenatal care or continuation of care without interruption for women who are pregnant when they enroll. The Contractor shall provide maternity care that includes prenatal, delivery, and postpartum care as well as care for conditions that complicate pregnancies. All newborn Members shall be screened for those disorders specified in the Commonwealth of Kentucky metabolic screen.
Maternity Care. Maternity care (pre-natal and post-natal) will be subject to a $10 office visit copayment but the 15 visit limit for doctor's office visits will not apply to maternity care. Effective September 1, 2014, or as soon thereafter as practicable, pursuant to PPACA, covered preventive care services will be paid in full when received from a participating provider.
Maternity Care. This benefit covers pre-natal and post-natal maternity (pregnancy) care; pre-natal testing for congenital disorders; childbirth (vaginal or cesarean); in utero treatment for the fetus; complications of pregnancy such as fetal distress, gestational diabetes, and toxemia; and related conditions for a female Subscriber or Dependent. Preventive pre- natal care is covered under the Preventive Care, Screening and Immunization Services benefit. Please see the Schedule of Benefits for specific Cost-Sharing information. The services of a licensed physician, an advanced registered nurse practitioner (ARNP), a licensed midwife, or a certified nurse midwife (CNM), as well as Facility fees associated with childbirth delivery in a Hospital or birthing center, are covered under this benefit. This benefit also covers the related routine nursery care of the newborn, including newly adopted children. Circumcisions are covered up to 28 days following birth. Circumcisions performed after 28 days must be Medically Necessary as determined by CHPW. Covered post-natal care includes lactation support and counseling. There is no limit for the mother and her newborn’s length of inpatient stay. Where the mother is attended by a physician, the attending physician will determine an appropriate discharge time, in consultation with the mother. This benefit covers Medically Necessary supplies of a home birth for low-risk Members.
Maternity Care. (a) There is a maximum benefit of two thousand five hundred dollars ($2,500) for each pregnancy with no deductible or coinsurance.
