Want to learn more about healthy pregnancy and save some money too? UHC, our medical network provider, offers a Maternity Management Program that provides prenatal education to all EWTF participants and spouses. The program focuses on promoting good health for mother and child to reduce the chances of a high-risk labor and delivery. The program also seeks to identify high-risk pregnancies to enroll members in the specialized obstetrical case management program to help guide them through a challenging pregnancy, and onto a safe and healthy labor and delivery. Those who participate in the Maternity Management Program will receive a higher coverage rate, and extra 5% from 80% of the allowable charges covered to 85% covered, on their obstetric medical charges.
Gynecological Care and Maternity Benefits
Benefits for gynecological and maternity care are payable on the same basis as expenses resulting from an illness. After you have satisfied your annual deductible, covered charges made by a surgeon or a physician are payable at 80% of the allowance. If you have participated in the free “Healthy Pregnancy Program” offered through UHC, benefits are payable at 85% (rather than 80%) of the allowance for delivery charges by the obstetrician. For information about child wellness visits and immunizations, see Your Medical Benefits. Dependent children are not eligible for maternity care.
“Maternity Management Program” and Pre-Natal Healthy Baby Program
UHC provides a prenatal education and information program to all EWTF members and spouses. The objective of this program is to promote good health for mother and child, and to reduce the incidence and severity of Neonatal Intensive Care Unit needs by identifying high-risk pregnancies and enrolling members into specialized obstetrical case management. The Plan covers allowable delivery charges for the attending obstetrician at 85% (rather than 80%) for those participants who have participated in this “Maternity Management Program.”
What You Need To Do
Contact UHC at 800-850-1418 as soon as you or your spouse’s pregnancy is confirmed to receive free pre-natal care information through the “Maternity Management Program.” If you have any questions regarding maternity benefits or payment of claims, please contact an EWTF Service Representative at (301) 731-1050.
Maternity
Maternity care expenses for a member or the member’s spouse can include emergency care, charges by physicians and surgeons in or out of the hospital, assistants or co-surgeons, and anesthesiologist’s charges. No maternity coverage is provided for a member’s pregnant child.
Hospital Expenses for Mother/Newborn Child
The first $7,000 of eligible expenses for room and board and other hospital services
are paid in full for both the covered mother and newborn child (100% of the allowance, no deductible applies). For expenses in excess of $7,000, the plan will pay 80% of
the allowance. You must notify the Fund office and enroll your newborn in the Plan within 30 days from birth. No coverage is provided for the newborn child of a covered dependent child.
Obstetrician’s Charges
The physician’s charges are paid at 80% of the allowance after you’ve satisfied your annual deductible. If you participated in the “Maternity Management Program,” the benefits are paid at 85% once the annual deductible is met.
Charges for global obstetrical/pregnancy services (antepartum care, delivery, and postpartum care) are paid after the birth of the child.
Services of a Midwife
The Plan pays 80% of the allowance for obstetrical services for delivery at home by a midwife. The midwife must be a certified nurse, work through a medically directed service organization and be under the direct supervision of a board certified Obstetrician-Gynecologist throughout pre-natal care, delivery, and during postpartum care. If the services of a nurse-midwife are used, no benefits are payable for charges by an obstetrician unless required due to complications.
Duration of Hospital Stay Following Childbirth
The Plan does not require that a provider obtain prior authorization from UHC or issuer for prescribing a length of stay less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section.