Maternity Care and Related Newborn Care Benefits. Outpatient and inpatient pre-natal and postpartum care and obstetrical services provided by Participating Providers are a Covered Benefit. The Participating Provider is responsible for obtaining any required pre-authorizations for all non-routine obstetrical services from HMO after the first prenatal visit. Coverage does not include routine maternity care (including delivery) received while outside the Service Area unless the Member receives pre-authorization from HMO. As with any other medical condition, Emergency Services are covered when Medically Necessary. As an exception to the Medically Necessary requirements of this Certificate, the following coverage is provided for a mother and newly born child:
Maternity Care and Related Newborn Care Benefits. Outpatient and inpatient pre-natal and postpartum care and obstetrical services provided by Participating Providers are a Covered Benefit. Coverage does not include routine maternity care (including delivery) received while outside the Service Area unless the Member receives pre-authorization from HMO. As with any other medical condition, Emergency Care is covered when Medically Necessary. As an exception to the Medically Necessary requirements of this Certificate, the following coverage is provided for a mother and newly born child:
Maternity Care and Related Newborn Care Benefits. Outpatient and inpatient pre-natal and postpartum care and obstetrical services provided by Participating Providers are a Covered Benefit. Services may be provided by Participating nurse-midwives, midwives and/or birth centers if available in HMO’s Service Area. The Participating Provider is responsible for obtaining any required pre-authorizations for all non-routine obstetrical services from HMO after the first prenatal visit. Coverage is provided for postdelivery care for the Member and her newborn infant. Coverage will include a postpartum assessment and newborn assessment to be provided at the hospital, the attending Physician’s office, an outpatient maternity center or in the Member’s home by a qualified licensed health care professional trained in mother and baby care. The services will include physical assessment of the newborn and mother, and the performance of any Medically Necessary clinical tests and immunizations in keeping with prevailing medical standards which are Covered Benefits under this Certificate. Coverage does not include routine maternity care (including delivery) received while outside the Service Area unless the Member receives pre-authorization from HMO. As with any other medical condition, Emergency Services are covered when Medically Necessary.
Maternity Care and Related Newborn Care Benefits. Outpatient and inpatient pre-natal and postpartum care and obstetrical services provided by Participating Providers are a Covered Benefit, including prenatal genetic testing of a fetus associated with high risk pregnancies, and voluntary participation in the Expanded Alpha Feto Protein (AFP) program, which is a California statewide prenatal testing program administered by the State Department of Health Services. The Participating Provider is responsible for obtaining any required pre-authorizations for all non-routine obstetrical services from HMO after the first prenatal visit. Coverage does not include routine maternity care received while outside the Service Area unless the Member receives pre-authorization from HMO. Coverage for Emergency Services, including Active Labor and Urgent Care is described in Emergency Services/Urgent Care Benefits. As an exception to the Medically Necessary requirements of this EOC, the following coverage is provided for a mother and newly born child:
Maternity Care and Related Newborn Care Benefits. Outpatient and inpatient pre-natal and postpartum care and obstetrical services (including but not limited to Medically Necessary pre-natal counseling and diagnosis of genetic and congenital disorders) provided by Participating Providers are a Covered Benefit. To be covered for these benefits, the Member is requested to choose either her PCP, or a Participating Women’s Health Care Specialist from HMO’s list of Participating Women’s Health Care Specialists, and inform HMO by calling the Member Services toll-free telephone number listed on the Member’s identification card, prior to receiving services. The Member’s PCP or Participating Women’s Health Care Specialist is responsible for obtaining any required pre-authorizations for all non-routine obstetrical services from HMO after the first prenatal visit. Coverage does not include routine maternity care (including delivery) received while outside the Service Area unless the Member receives pre-authorization from HMO. However, if the Member’s health care Provider was consulted prior to travel, and determined that travel outside the Service Area posed no danger, coverage will include Covered Benefits for premature birth expenses. As with any other medical condition, Emergency Services are covered when Medically Necessary. As an exception to the Medically Necessary requirements of this Certificate, the following coverage is provided for a mother and newly born child:
Maternity Care and Related Newborn Care Benefits. Outpatient and inpatient prenatal and postpartum care and obstetrical services provided by Participating Providers are a Covered Benefit. The Participating Provider is responsible for obtaining any required pre-authorizations for all non-routine obstetrical services from HMO’s Medical Director or Designee after the first prenatal visit. Except to the extent of any applicable Deductibles, Copayments or coinsurance the Member will not be held liable for Covered Benefits for which the Participating Provider has not received prior authorization from HMO’s Medical Director or Designee. Coverage includes prenatal HIV testing ordered by a Participating Physician or by a Participating Health Professional who has a written agreement with a Participating Physician which authorizes these services. Coverage does not include routine maternity care (including delivery) received while outside the Service Area unless the Member receives pre-authorization from HMO’s Medical Director or Designee, or is outside the Service Area due to circumstances beyond her control. As with any other medical condition, Emergency Services are covered when Medically Necessary. As an exception to the Medically Necessary requirements of this Certificate, the following coverage is provided for a mother and newly born child:
