Maternity and Newborn Care. This plan covers health care providers and facility charges for prenatal care, delivery and postnatal care for all covered female members. Hospital stays for maternity and newborn care are not limited to less than 48 hours for a vaginal delivery or less than 96 hours following a cesarean section. A length of stay that will be longer than these limits must be prior authorized. See Prior Authorization for details. Newborn children are covered automatically for the first 3 weeks from birth when the mother is eligible to receive obstetrical care benefits under this plan. To continue benefits beyond the 3-week period, please see the dependent eligibility and enrollment guidelines outlined under Eligibility and Enrollment. This benefit covers: Prenatal and postnatal care and screenings (including in utero care) Home birth services including associated supplies provided by a licensed women’s health care provider who is working within their license and scope of practice Nursery services and supplies for newborn Genetic testing of the child’s father is covered This benefit does not cover: Outpatient x-ray, lab and imaging. These services are covered under Diagnostic Lab, X-ray and Imaging. Home birth services provided by family members or volunteers Home Health Care Home health care services must be part of a home health care plan. These services are covered when a qualified provider certifies that the services are provided or coordinated by a state-licensed or Medicare-certified home health agency or certified rehabilitation agency. Covered services provided and billed by a home health agency include: Home visits and acute nursing (short-term nursing care for illness or injury) Home medical equipment, medical supplies and devices Prescription drugs and insulin provided by and billed by a home health care provider or home health agency Therapeutic services such as respiratory therapy and phototherapy This benefit does not cover: Over-the-counter drugs, solutions and nutritional supplements Services provided to someone other than the ill or injured member Services provided by family members or volunteers Services or providers not in the written plan of care or not named as covered in this benefit Custodial care Nonmedical services, such as housekeeping Services that provide food, such as Meals on Wheels or advice about food Hospice Care A hospice care program must be provided in a hospice facility or in your home by a hospice care a...
Maternity and Newborn Care. 3.13.5 Mental Health and Substance Use Disorder Services, including Behavioral Health Treatment;
Maternity and Newborn Care. The Company will implement a copay of $25 for maternity care (pre- and post-natal), at the initial visit only, on an in-network basis. Maternity care (pre- and post-natal) will be covered after the deductible is met on an in-network basis at 90% of the NNF; and, after the deductible is met on an out-of-network basis at 60% of the MAA. Birthing center charges will be covered after the deductible is met on an in-network basis at 90% of the NNF; and, after the deductible is met on an out-of-network basis at 60% of the MAA. Newborn baby care will be covered after the deductible is met on an in-network basis at 90% of the NNF; and, after the deductible is met on an out-of-network basis at 60% of the MAA. (Amend the following sections of the FMEP: Sections 5.1.2, 5.1.3 and 8.10.)
Maternity and Newborn Care. The Company will continue to implement a copay of $20 for maternity care (pre- and post-natal), at the initial visit only, on an in-network basis. Maternity care (pre- and post-natal) will be covered after the deductible is met on an in-network basis at 90% of the NNF and on an out-of-network basis at 60% of the MAA. Birthing center charges will be covered after the deductible is met on an in-network basis at 90% of the NNF and on an out-of-network basis at 60% of the MAA. Newborn baby care will be covered after the deductible is met on an in- network basis at 90% of the NNF and on an out-of-network basis at 60% of the MAA. (Amend the following sections of the VMEP: Sections 6.2, 6.2.2, 6.2.4, and 9.9.)
Maternity and Newborn Care. We Cover services for maternity care provided by a Physician or midwife, nurse practitioner, Hospital or birthing center. We Cover prenatal care (including one (1) visit for genetic testing), postnatal care, delivery, and complications of pregnancy. We will not pay for duplicative routine services provided by both a midwife and a Physician. See the Inpatient Services section of this Certificate for coverage of Inpatient maternity care. If You are pregnant when coverage begins and are in the first trimester of the pregnancy, You must change to a Network Provider to have Covered Services paid at the Network level. If You are pregnant when coverage begins and are in Your second or third trimester of pregnancy (13 weeks or later), You may continue obstetrical care with Your Non-Network Provider through the end of the pregnancy and the immediate post-partum period. However, You must notify Us of Your intention to remain with Your Non-Network Provider. We Cover breastfeeding support, counseling and supplies, not subject to Copayments, Deductibles or Coinsurance, including the cost of renting or the purchase of one (1) breast pump per Benefit Period.
Maternity and Newborn Care. Maternity and neonatal care services are available for the main insured, spouse, and direct dependents of the main insured. Maternity Services (Prenatal) Pre and postnatal care will be paid as any other visit. Corresponding copayment or coinsurance for general practitioner, specialist, or subspecialist applies. Initial deductible applies/No initial deductible applies. Coverage for care within hospital facilities for the mother and her newborn copayment or coinsurance applies according to the hospital classification Level I or Level 2. Hospital level is shown in the Providers Directory 1, 2, 3, 6 applicable to this certificate./ Copayment or coinsurance for hospitalization applies. Initial deductible applies/No initial deductible applies. Minimum forty- eight (48) hour coverage will be provided for care within hospital facilities for the mother and the newborn for natural birth, and ninety- six (96) hours for Cesarean section, in accordance with Law No. 248 of August 15, 1999. MCS Life will cover the following maternity services and the insured is responsible for applicable copayments or coinsurances Initial deductible applies/No initial deductible applies. Hospital and outpatient obstetric services. Corresponding copayment or coinsurance for facility or hospital applies. Obstetric sonographies up to three (3-100) per pregnancy . Copayment or coinsurance for X-rays applies. Biophysical profile, limited to one (1) per pregnancy, additional ones require pre-authorization from MCS Life Clinical Affairs Department. Copayment or coinsurance for X-rays applies Fetal Non-Stress Test up to one (1-100) per pregnancy. Copayment or coinsurance for X-rays applies. Fetal echocardiogram requires pre-authorization from MCS Life Clinical Affairs Department. Copayment or coinsurance for X-rays applies. Amniocentesis (genetic) up to one (1-100) per pregnancy. No copayment or coinsurance applies. Amniocentesis (fetal maturation). No copayment or coinsurance applies. Requires pre-authorization from MCS Life Clinical Affairs. Hospital services. Copayment or coinsurance applies, according to hospital classification Level 1 or Level 2. Hospital level is shown in Providers Directory 1, 2, 3, 6 applicable to this certificate. / Copayment or coinsurance for hospitalization applies. Delivery room or for Cesarean section. Copayment or coinsurance applies, according to hospital classification Level 1 or Level 2 applies. Hospital level is shown in Providers Directory 1, 2, 3, 6 applicab...
