Page 16 - Covered 6 Employee Benefits 2021-2022

child to less than 48 hours following a vaginal delivery, or less than 96 hours following a
cesarean section.

However, federal law generally does not prohibit the mother’s or newborn’s attending
provider, after consulting with the mother, from discharging the mother or her newborn earlier
than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under federal
law, require that a provider obtain Authorization from the plan or the issuer for prescribing a
length of stay not in excess of 48 hours (or 96 hours).

Under California law, if your Plan provides benefits for obstetrical services your benefits will
include coverage for postpartum services. Coverage will include benefits for inpatient care
and a home visit or visits, which shall be in accordance with the medical criteria, outlined in
the most current version of or an official update to the “Guidelines for Perinatal Care" prepared
by the American Academy of Pediatrics and the American College of Obstetricians and

Gynecologists or the "Standards for Obstetric‐Gynecologic Services" prepared by the
American College of Obstetricians and Gynecologists. Coverage for obstetrical services as an
inpatient in a general Hospital or obstetrical services by a Physician shall provide such
benefits with durational limits, deductibles, coinsurance factors, and Copayments that are no
less favorable than for physical Illness generally.

Patient Protection Disclosure

The group health plan or health insurance issuer generally requires the designation of a primary
care provider if enrolling in a Health Maintenance Organization (HMO) plan. You have the right to
designate any primary care provider who participates in the network and who is available to accept
you or your family members. If you do not make this designation, the group health plan or health
insurance issuer will designate one for you or your family members. You have the right to change
your provider for any reason. For information on how to select a primary care provider, and for a
list of the participating primary care providers, contact the Plan Administrator. For children, you
may designate a pediatrician as the primary care provider.

You do not need prior authorization from the group health plan or issuer or from any other person
(including a primary care provider) in order to obtain access to obstetrical or gynecological care
from a health care professional in our network who specializes in obstetrics or gynecology. The
health care professional, however, may be required to comply with certain procedures, including
obtaining prior authorization for certain services, following a pre‐approved treatment plan, or
procedures for making referrals. For a list of participating health care professionals who specialize in
obstetrics or gynecology, contact the Plan Administrator.

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