Newborn Care. A newborn child will be covered from the moment of birth provided that the newborn child is eligible for coverage and properly enrolled. Covered Services will consist of coverage for injury or illness, including the necessary care or treatment of medically diagnosed congenital defects, birth abnormalities, premature birth and transportation costs to the nearest facility appropriately staffed and equipped to treat the newborn's Condition, when such transportation is Medically Necessary. Circumcisions are provided for up to one year from the date of birth.
Newborn Care. A newborn of a Member will be Covered from the moment of birth when enrolled as follows: • We must receive the signed and completed enrollment Application for the newborn that was submitted to the employer Group within 31 days from the date of birth. • If enrollment of a newborn results in an increase to the amount of Prepayment due, the applicable Prepayment must be paid with the signed enrollment Application within the first 31 days following the date of birth. • If the above conditions are not met, we will not enroll the newborn for Coverage until the next Annual Group Enrollment Period. • Neonatal care is available for the newborn of a Member for at least 48 hours of Inpatient care following a vaginal delivery and at least 96 hours of Inpatient care following a Cesarean section. If the mother is discharged from the Hospital and the newborn remains in the Hospital, it is considered a separate Hospital stay and requires Prior Authorization. Refer to your Summary of Benefits and Coverage for your Cost Sharing amount. • Benefits for a newborn who is a Member shall include Coverage for injury or sickness including the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities. Where necessary to protect the life of the infant Coverage includes transportation, including air Ambulance Services to the nearest available Tertiary facility. Newborn Member benefits also include Coverage for newborn visits in the Hospital by the baby’s Practitioner/Provider, circumcision, incubator, and routine Hospital nursery charges. • A newborn of a Member’s Dependent child cannot be enrolled unless the newborn is legally adopted by the Subscriber, or the Subscriber is appointed by the court as the newborn’s legal guardian.
Newborn Care. The newborn child of a Member shall be entitled to benefits provided by this plan from the date of birth up to a maximum of thirty-one (31) days. Such coverage within the thirty-one (31) days shall include care which is necessary for the treatment of medically diagnosed congenital defects, birth abnormalities, prematurity and routine nursery care. Coverage for a newborn may be continued beyond thirty-one (31) days under conditions specified in the Section EL - Eligibility, Change and Termination Rules Under the Plan of this Agreement. If a Deductible applies to the Member’s coverage, only one facility provider Deductible will be applied when the mother and newborn are discharged from the Hospital; however, Deductibles for other Professional Providers may also apply. If the newborn remains in the Hospital after the mother is discharged or if the newborn is transferred to another Hospital, another individual Deductible will not need to be met before eligible claims are paid for the newborn.
Newborn Care. Covered Services will be provided to the newborn child of a Member from the moment of birth and shall include care which is necessary for the treatment of medically diagnosed congenital defects, birth abnormalities, prematurity and routine nursery care. Routine nursery care includes Inpatient medical visits by a Professional Provider. Such Benefits shall continue for a maximum of thirty-one (31) days from birth, subject to the termination provisions set forth in Subsection B. BENEFITS AFTER TERMINATION OF COVERAGE of SECTION GP - GENERAL PROVISIONS of this Agreement.
Newborn Care. Medical services and supplies for a newborn child following birth to a female Subscriber or an enrolled Dependent, including newborn Hospital nursery charges, the initial physical examination and a PKU test, are covered. Benefits apply under the newborn's own coverage, in connection with nursery care for a natural newborn or newly adopted child. Coverage for newborns, including xxxxxxxx born to dependent female children, is provided for the first 3 weeks of life as described in the Schedule of Medical Benefits, even if the newborn is not enrolled. Benefits will be provided at a level not less than the enrolled mother’s coverage, even in the event of separate Hospital admissions. For coverage to continue after the first 3 weeks of life, the newborn child must be eligible and enrolled, as explained in the Eligibility and Enrollment sections. Coverage for nutritional and dietary formulas, including elemental formulas, and medical foods, is provided when Medically Necessary. The following conditions must be met: • The formula is a specialized formula for treatment of a recognized life-threatening metabolic deficiency such as phenylketonuria; or • The formula is the significant source of a patient’s primary nutrition or is administered in conjunction with intravenous nutrition; and • The formula is administered through a feeding tube (nasal, oral or gastrostomy). Coverage for oral surgery is provided when medically necessary and related to trauma or injury and where such services or appliances are necessary for or resulting from emergency medical treatment, or where the extraction of teeth is required to prepare the jaw for radiation treatments of certain conditions. Oral Surgery required for a dental diagnosis such as periodontal disease is not covered. Examples of Covered Services include: • The reduction or manipulation of fractures of facial bones; • Excision of lesions, cysts, and tumors of the mandible, mouth, lip or tongue; and • Incision of accessory sinuses, mouth salivary glands or ducts.
Newborn Care. A newborn child who is properly enrolled will be covered from the moment of birth for injury or illness, including the necessary care or treatment of medically diagnosed congenital defects, birth abnormalities, and premature birth.
Newborn Care e. Bowel/bladder function;
f. Perineal exam and assessment;
g. Repair of episiotomy or laceration, as indicated;
h. Facilitation of maternal-infant bonding and family adjustment; and
i. Maternal nutritional status assessment.
Newborn Care i. Infant resuscitation - first ¼ hour (or part thereof) $110.55
ii. Infant resuscitation- second ¼ hour (or part thereof) $55.20
iii. Infant resuscitation- after first ½ hour, per ¼ hour (or part thereof) $36.35
iv. Infant resuscitation with endotracheal intubation $38.35
v. Newborn Care in Hospital or Home $52.20 Fees will not be paid for normal newborn care when claiming for a delivery fee.
Newborn Care. The Health Plan shall make certain that its Providers supply the highest level of care for the Newborn beginning immediately after birth. Such level of care shall include, but not be limited to, the following:
(i) Instilling of prophylactic eye medications into each eye of the Newborn;
(ii) When the mother is Rh negative, the securing of a cord blood sample for type Rh determination and direct Xxxxxx test;
(iii) Weighing and measuring of the Newborn;
(iv) Inspecting the Newborn for abnormalities and/or complications;
(v) Administering of one half milligram of vitamin K;
(vi) XXXXX scoring;
(vii) Any other necessary and immediate need for referral in consultation from a specialty physician, such as the Healthy Start (postnatal) infant screen; and
(viii) Any necessary Newborn and infant hearing screenings (to be conducted by a licensed audiologist pursuant to Chapter 468, F.S., a physician licensed under Chapters 458 or 459, F.S., or an individual who has completed documented training specifically for newborn hearing screenings and who is directly or indirectly supervised by a licensed physician or a licensed audiologist).
Newborn Care. The PSN shall make certain that its Providers supply the highest level of care for the Newborn beginning immediately after birth. Such level of care shall include, but not be limited to, the following:
i. Instilling of prophylactic eye medications into each eye of the Newborn;
ii. When the mother is Rh negative, the securing of a cord blood sample for type Rh determination and direct Xxxxxx test;
iii. Weighing and measuring of the Newborn;
iv. Inspecting the Newborn for abnormalities and/or complications;
v. Administering of one half milligram of vitamin K;
vi. XXXXX scoring;
vii. Any other necessary and immediate need for referral in consultation from a specialty physician, such as the Healthy Start (postnatal) infant screen; and
viii. Any necessary Newborn and infant hearing screenings. Screenings are to be conducted by a licensed audiologist pursuant to Chapter 468, F.S., 2004, a physician licensed under Chapters 458 or 459, F.S., 2004, or an individual who has completed documented training specifically for newborn hearing screenings and who is directly or indirectly supervised by a licensed physician or a licensed audiologist.
