Enrollment of a Pregnant Woman and Her Unborn Child for the Basic Benefits Package Sample Clauses

Enrollment of a Pregnant Woman and Her Unborn Child for the Basic Benefits Package. During the enrollment process, an eligible pregnant woman shall be required to choose the same plan, but not necessarily the same PCP, for herself and her eligible unborn/newborn child. Enrollment changes (i.e., to a different plan or PCP) may be made as often as allowed for any other client participating in the NHC, as long as mother and unborn/newborn are both enrolled with the same plan. The following shall apply: (a) The requirement for mother and unborn/newborn to be in the same plan extends through the postpartum period, defined as the end of the month in which the 60th day following the end of pregnancy occurs; (b) The mother and unborn/newborn may be enrolled in separate plans when requested by the client based on good cause. Good cause includes, but is not limited to, situations in which one plan is unable to meet the needs of both clients despite reasonable efforts to accommodate their needs; and (c) The request for enrollment in separate plans shall be submitted to the EBS, who gathers any necessary information. The request is then submitted to the Department within two (2) working days. The Department shall approve or deny the request within five (5) working days. The client and PCP/plans are notified of the approval or denial of the request by the Department.
Sample 1
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