2020 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals
Page 48
 
Benefit Description

Maternity Care

We encourage you to notify us of your pregnancy during the first trimester, see page 24.

Maternity (obstetrical) care including related conditions resulting in childbirth or miscarriage, such as:

 
  • Prenatal care (including ultrasound, laboratory, and diagnostic tests)
     
  • Delivery
     
  • Postpartum care

    Note: We cover up to 4 visits per year in full to treat depression associated with pregnancy (i.e., depression during pregnancy, postpartum depression, or both) when you use a Preferred provider. See Section 5(e) for our coverage and benefits for additional mental health services.

     
  • Assistant surgeons/surgical assistance if required because of the complexity of the delivery
     
  • Anesthesia (including acupuncture) when requested by the attending physician and performed by a certified registered nurse anesthetist (CRNA) or a physician other than the operating physician (surgeon) or the assistant
     
  • Tocolytic therapy and related services when provided on an inpatient basis during a covered hospital admission
     
  • Breastfeeding education and individual coaching on breastfeeding by healthcare providers such as physicians, physician assistants, midwives, nurse practitioners/clinical specialists, and lactation consultants

    Note: See page 49 for our coverage of breast pump kits.

     
  • Home nursing visits (skilled), subject to visit limitation stated on page 57

Notes:
 
  • See pages 43 and 47 for our coverage of nutritional counseling.
     
  • Maternity care benefits are not provided for prescription drugs required during pregnancy, except as recommended under the Affordable Care Act. See page 98 for more information. See Section 5(f) for other prescription drug coverage.

Here are some things to keep in mind:
 
  • You do not need to precertify your delivery; see page 26 for other circumstances, such as extended stays for you or your newborn.
     
  • You may remain in the hospital up to 48 hours after a vaginal delivery and 96 hours after a cesarean delivery. We will cover an extended stay if medically necessary.
     
  • We cover routine nursery care of the newborn when performed during the covered portion of the mother’s maternity stay and billed by the facility. We cover other care of a newborn who requires professional services or non-routine treatment, only if we cover the newborn under a Self Plus One or Self and Family enrollment. Surgical benefits apply to circumcision when billed by a professional provider for a male newborn.
     
  • Hospital services are listed in Section 5(c) and Surgical benefits are in Section 5(b).

You Pay
Preferred: Nothing (no deductible)

Note: For Preferred facility care related to maternity, including care at Preferred birthing facilities, your responsibility for covered facility care is limited to $1,500 per pregnancy. See Section 5(c), page 74.

Non-preferred (Participating/Non-participating): You pay all charges

Note: When care is provided by a Non-preferred laboratory and/or radiologist, as stated on page 18 for an exception, you pay:

 
  • Participating laboratories or radiologists: Nothing (no deductible)
     
  • Non-participating laboratories or radiologists: The difference between our allowance and the billed amount (no deductible)
 
Maternity Care - continued on next page