MMC Benefits Handbook
Maternity
Who is eligible for maternity coverage?
Maternity coverage is available to eligible covered participants.
Do I need to have my maternity coverage preauthorized?
No. Preauthorization within 48 hours is not required for the initial hospital admission.
You must notify the preauthorization service if the mother or her newborn stay in the hospital longer than 48 hours after a vaginal delivery or 96 hours after a Cesarean birth. This notification must occur within 24 hours of the determination to extend the stay.
Does the Plan cover prenatal visits?
Note that routine prenatal care, as defined by the Department of Health and Human Services, is covered with no cost sharing (i.e. deductibles, coinsurance) for all plans.
The Plan covers prenatal visits in-network at:
Under the $1,600 Deductible Plan
- 80% for in-network providers after the Plan deductible has been met.
Under the $3,200 Deductible Plan
After the first visit, subsequent visits are typically billed as part of doctor's delivery fee, which is also reimbursed at:
Under the $1,600 Deductible Plan
Under the $3,200 Deductible Plan
The Plan covers prenatal visits out-of-network at:
Under the $1,600 Deductible Plan
- 60% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
Under the $3,200 Deductible Plan
- 50% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
What will the Plan pay for the doctor's charge for delivering the baby?
The Plan covers charges for delivery of the baby at:
Under the $1,600 Deductible Plan
- 80% for in-network providers and 60% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
Under the $3,200 Deductible Plan
- 70% for in-network providers and 50% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
What will the Plan pay for the doctor's charge for examining the baby?
The Plan covers the charges for your baby's first examination in the hospital at:
Under the $1,600 Deductible Plan
- 80% for in-network providers and 60% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
Under the $3,200 Deductible Plan
- 70% for in-network providers and 50% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
A child is covered at birth as long as the baby meets the child eligibility requirements and is enrolled within 60 days of the birth.
What will the Plan pay for hospital charges for the mother and the baby?
The Plan covers hospital charges for maternity admissions at:
Under the $1,600 Deductible Plan
- 80% for in-network providers and 60% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
Under the $3,200 Deductible Plan
- 70% for in-network providers and 50% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
The Plan covers newborn nursery care at:
Under the $1,600 Deductible Plan
- 80% for in-network providers and 60% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
Under the $3,200 Deductible Plan
- 70% for in-network providers and 50% of reasonable and customary charges for out-of-network providers after the Plan's deductible has been met.
A child is covered at birth as long as the baby meets the child eligibility requirements and is enrolled within 60 days of the birth.
The mother and the newborn child are covered for a minimum of 48 hours of care following a vaginal delivery and 96 hours following a Cesarean section. However, the mother's provider may — after consulting with the mother — discharge the mother earlier than 48 hours following a vaginal delivery (96 hours following a Cesarean section).
You must notify the Claims Administrator within 24 hours of a determination to extend the stay.
Does the Plan cover midwife services?
The Plan covers midwives who are in practice with a network group at:
Under the $1,600 Deductible Plan
- 80% for in-network providers and 60% of reasonable and customary charges for out-of-network providers in association with a supervising physician after the Plan's deductible has been met.
Under the $3,200 Deductible Plan
- 70% for in-network providers and 50% of reasonable and customary charges for out-of-network providers in association with a supervising physician after the Plan's deductible has been met.
What is the wellness program for Maternity?
The Anthem BCBS Building Healthy Families Program provides tools and information to help your whole family have a successful pregnancy. This digital program can help support your family from preconception through the stages of pregnancy, childbirth, and early childhood (to age 5 and beyond). It is available 24/7 through Anthem's Sydney Health mobile app, and at www.anthem.com, and features an extensive content library covering topics to support diverse families, including single parents and same-sex or multicultural couples. In addition, the app features many tools including fertility, diaper change, and feeding trackers, due date calculators, and blood pressure monitoring. Visit the Sydney Health mobile app or www.anthem.com to enroll.
If my dependent child has a baby does the Plan cover the newborn child?
Unless the newborn meets the definition of an eligible child and is covered under the Plan, medical care for the newborn, whether in or out of the hospital, is not covered.