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Maternity Services

Benefits for Covered Health Care Services incurred by you or your Enrolled Dependent Spouse or daughter for a
normal Pregnancy and for childbirth. Benefits include Covered Health Care Services for a cesarean section.

We will provide these Benefits on the same basis as we pay for Benefits for a Sickness, according to:
· Guidelines established by the American College of Obstetricians and Gynecologists; or
· Any other established professional medical association.

For inpatient care at a Hospital, we will provide Benefits for the mother for up to:

· 48 hours following a vaginal delivery; or
· 96 hours following an elective or scheduled cesarean section.
The mother is not required:

· To give birth in a Hospital; or

· To stay in the Hospital for these minimum hours.
The above hours do not prohibit the mother and her Physician from both deciding on an earlier discharge.
For multiple births, the 48 or 96 hours begin at the time of the last child's delivery. If delivery happens outside of a
Hospital, the 48 or 96 hours begin when the mother is admitted to the Hospital for the birth. A determination of
whether to admit the mother to a Hospital for childbirth is made by the Physician.

For purposes of this provision, a Physician may be a person such as a nurse midwife or a physician assistant,
who is:
· Licensed under applicable state law to provide maternity care;
· Directly responsible for providing maternity care to the mother; and

· Providing the care.

For purposes of this provision, a Hospital includes a licensed, free-standing birthing facility that provides services
for:
· Prenatal care;
· Delivery;

· Immediate postpartum care; and

· Care of the child born at the center.
Covered Health Care Services incurred at a free standing birthing facility are provided on the same basis as
maternity Benefits received at a Hospital. The same inpatient care time periods apply for maternity care received
at a free standing birthing facility as for similar care received at a Hospital.

We will provide Benefits for Complications of Pregnancy the same as for a Sickness.

Follow-up Care
We will provide Benefits for Physician-directed follow-up care on the same basis as we pay for Benefits for a
Sickness.
Follow-up care services include:
· Physical assessment of the mother and newborn;

· Parent education;

· Help and training in breast or bottle feeding;
· Assessment of the home support system;
· Performance of any Medically Necessary and appropriate clinical tests; and

Page 27 Section 5- Additional Coverage Details
PPO - 2017