2020 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(c). Services Provided by a Hospital or Other Facility, and Ambulance Services
Page 75
 
Benefit Description

Maternity – Facility (cont.)

Notes:

 
  • 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 page 48.
     
  • Preventive care benefits apply to the screening of pregnant members for syphilis and unhealthy alcohol use/substance use when billed by a facility.

Room and board, such as:
 
  • Semiprivate or intensive care accommodations
     
  • General nursing care
     
  • Meals and special diets

Other inpatient hospital services and supplies, such as:
 
  • Administration of blood or blood plasma
     
  • Anesthetics and anesthesia services
     
  • Breastfeeding education
     
  • Covered medical supplies and equipment, including oxygen
     
  • Delivery, operating, recovery, and other treatment rooms
     
  • Diagnostic studies, radiology services, laboratory tests, and pathology services
     
  • Dressings and sterile tray services
     
  • Nutritional counseling
     
  • Prescribed drugs and medications
     
  • Take-home items

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 if billed by a professional provider for a male newborn.
     
  • When a newborn requires definitive treatment during or after the mother’s confinement, the newborn is considered a patient in his or her own right. Regular medical or surgical benefits apply rather than maternity benefits.
     
  • See page 60 for our payment levels for circumcision.
     
  • Note: For inpatient care received overseas, refer to Section 5(i), page 109.

You Pay
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