Elective Care. Elective care or care required as a result of circumstances that could reasonably have been foreseen prior to the Enrollee’s departure from the Service Area is not covered. Unexpected hospitalization due to complications of pregnancy shall be covered. Routine delivery at term outside the Service Area, however, shall not be covered if the Enrollee is outside the Service Area against medical advice unless the Enrollee is outside of the Service Area due to circumstances beyond her control. The Contractor must educate the Enrollee regarding the medical and financial implications of leaving the Service Area and the importance of staying near the treating Provider throughout the last month of pregnancy.
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