Maternity and Obstetrical Care Services. 1. Maternity/Obstetrical Care Services rendered in the care and management of a Member’s pregnancy are Covered Services under this plan. The Member’s Obstetrician or Gynecologist will notify Keystone of their maternity care visit. Covered Services include: (1) facility services provided by a Participating Facility Provider that is a Hospital or Birth Center; and (2) professional services performed by an Obstetrician or Gynecologist that is a Physician or a certified nurse midwife. Benefits are also payable for certain services provided by an Obstetrician or Gynecologist for elective home births. Under federal law, health plans and health insurance issuers generally may not restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a delivery by cesarean section. However, the plan or issuer may pay for a shorter stay if the attending provider (e.g., physician, nurse midwife, or physician assistant), after consultation with the mother, discharges the mother or newborn earlier. Also, under federal law, plans and issuers may not set the level of benefits or out-of-pocket costs so that any later portion of the 48-hour (or 96-hour) stay is treated in a manner less favorable to the mother or newborn than any earlier portion of the stay. In addition, a plan or issuer may not, under federal law, require that a physician or other health care provider obtain authorization for prescribing a length of stay of up to 48 hours (or 96 hours). However, to use certain providers or facilities, or to reduce out-of-pocket costs, Members may be required to obtain Precertification. For information on Precertification, contact the plan administrator.
Appears in 10 contracts
Samples: Subscriber Agreement, Subscriber Agreement, Subscriber Agreement
