Situation

CHOICE PLUS

NETWORK

CHOICE PLUS

NON-NETWORK

Maternity Services

Mother

Includes prenatal care, delivery, postnatal care and any related complications.

We will pay Benefits for an Inpatient Stay of at least:

●  48 hours for the mother

and newborn child following a normal vaginal delivery.

●  96 hours for the mother

and newborn child following a cesarean section delivery.

If the mother agrees, the attending provider may discharge the mother and/or the newborn child earlier than these minimum time frames.

The following services are not covered:

●  Services provided by a

doula (labor aide);

●  Parenting, pre-natal or

birthing classes; and

●  Fetal surgery, unless as

described under Congenital Heart Disease

Same as:

●  Physician's Office

Services

●  Professional Fees

●  Hospital-Inpatient Stay

●  Outpatient Diagnostic

and Therapeutic Services.

Physician Office Services:

$20 copay per visit then 100% of eligible expenses.

Specialist Office Services:

$35 copay per visit then 100% of eligible expenses.

90% of eligible expenses for services relating to the delivery of the newborn.

Same as:

●  Physician's Office

Services

●  Professional Fees

●  Hospital-Inpatient Stay

●  Outpatient Diagnostic

and Therapeutic Services.

80% of eligible expenses after satisfying $300 deductible.

Notify Care Coordination

Please remember that for Benefits you must notify Care Coordination as soon as reasonably possible if the Inpatient Stay for the mother and/or the newborn will be more than the time frames described.

If you don't notify Care Coordination, Benefits will be subject to a $300 penalty.

Neonatal Resource Services (NRS)

Not Applicable

Not Applicable

Newborn Care

90% of eligible expenses, including circumcision.

80% of eligible expenses after satisfying $300 deductible, including circumcision.

Midwife

Covered same as Maternity Services Mother and Newborn Care sections above.

Covered same as Maternity Services Mother and Newborn Care sections above.

Birthing Center

Covered same as Maternity Services Mother and Newborn Care sections above.

Covered same as Maternity Services Mother and Newborn Care sections above.

The Healthy Pregnancy Program

A healthy pregnancy is the first step to a healthy baby and mother.  The Healthy Pregnancy Program provides health assessments, customized educational materials, and maternity nurse support throughout your pregnancy. Every enrollee in The Healthy Pregnancy Program is eligible to receive a complimentary Healthy Baby Bag by sending in the postage paid business reply card that will accompany the welcome packet after enrollment.

Call 1-800-411-7984

Or Visit

www.healthy-pregnancy.com