Common use of Maternity Care and Related Newborn Care Benefits Clause in Contracts

Maternity Care and Related Newborn Care Benefits. Outpatient and inpatient pre-natal and postpartum care and obstetrical services provided by Participating Providers are a Covered Benefit. The Participating Provider is responsible for obtaining any required pre-authorizations for all non-routine obstetrical services from HMO after the first prenatal visit. Coverage does not include routine maternity care (including delivery) received while outside the Service Area unless the Member receives pre-authorization from HMO. As with any other medical condition, Emergency Services are covered when Medically Necessary. As an exception to the Medically Necessary requirements of this Certificate, the following coverage is provided for a mother and newly born child: 1. a minimum of 48 hours of inpatient care in a Participating Hospital following a vaginal delivery; 2. a minimum of 96 hours of inpatient care in a Participating Hospital following a cesarean section; or 3. a shorter Hospital stay, if requested by a mother, and if determined to be medically appropriate by the Participating Providers in consultation with the mother.