Common use of Newborn Care Clause in Contracts

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. 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 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. A newborn of a Member will be Covered from the moment of birth when enrolled as follows: • We must Your newborn or the newborn of your Spouse will be Covered from the moment of birth if we receive the signed and completed enrollment Application for the newborn that was submitted to the employer Group Qualifying Event Form within 31 60 days from the date of birth. • If enrollment the Qualifying Event Form is not received within 60 days of a the birth, then the 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 birthis not eligible for family coverage. • 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. A newborn of a Member will be Covered from the moment of birth when enrolled as follows: • We must Your newborn or the newborn of your Spouse will be Covered from the moment of birth if we receive the signed and completed enrollment Application for the newborn that was submitted to the employer Group Qualifying Event Form within 31 60 days from the date of birth. • If enrollment the Qualifying Event Form is not received within 60 days of a the birth, then the 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 birthis not eligible for family coverage. • 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 the maternity section of 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. 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 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. 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. A newborn of a Member will be Covered from the moment of birth when enrolled as follows: • We must Your newborn or the newborn of your Spouse will be Covered from the moment of birth if we receive the signed and completed enrollment Application for the newborn that was submitted to the employer Group Qualifying Events Form within 31 60 days from the date of birth. • If enrollment the Qualifying Events Form is not received within 60 days of a the birth, then the 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 birthis not eligible for family coverage. • 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. 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. 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 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. 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. Additional Women’s Healthcare Benefits • Mammography and Diagnostic Mammography Coverage. • Mastectomy, Prophylactic Mastectomy, Prosthetic Devices and Reconstructive surgery. All care requires Prior Authorization. o Coverage for Medically Necessary surgical removal of the breast (mastectomy) is for not less than 48 hours of Inpatient care following a mastectomy and not less than 24 hours of Inpatient care following a lymph node dissection for the treatment of breast cancer, unless you and the attending Practitioner/Provider determine that a shorter period of Hospital stay is appropriate. o Coverage for minimum Hospital stays for mastectomies and lymph node dissections for the treatment of breast cancer is subject to Cost Sharing amounts consistent with those imposed on other benefits. Refer to your Summary of Benefits and Coverage for Cost Sharing amounts. o Coverage is provided for external breast prostheses following Medically Necessary surgical removal of the breast (mastectomy). Two bras per year are Covered for Members with external breast prosthesis. o As an alternative, post mastectomy reconstructive breast surgery is provided, including nipple reconstruction and/or tattooing, tram flap (or breast implant if necessary), and reconstruction of the opposite breast if necessary to produce symmetrical appearance. o Prostheses and treatment for physical complications of mastectomy, including lymphedema are Covered at all stages of mastectomy. • Osteoporosis Coverage for services related to the treatment and appropriate management of osteoporosis when such services are determined to be Medically Necessary. • The Alpha-fetoprotein IV screening test for pregnant women, generally between 16 and20 weeks for pregnancy, to screen for certain genetic abnormalities in the fetus. • Coverage for the preventive screening of women who have family members with breast, ovarian, tubal or peritoneal cancers with one of several screening tools designed to identify a family history that may be associated with an increased risk for potentially harmful mutations in breast cancer susceptibility genes (BRCA 1 or BRCA 2). • Women with positive screening results may receive genetic counseling and, if indicated after counseling, BRCA testing as determined by her healthcare provider.

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. ‌ 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 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. 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 Maternity and delivery section of 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. Additional Women’s Healthcare Benefits • Mammography and Diagnostic Mammography Coverage. • Mastectomy, Prophylactic Mastectomy, Prosthetic Devices, Prophylactic Oophorectomy, Risk Reduction Surgery, and Reconstructive surgery. Some care requires Prior Authorization. o Coverage for Medically Necessary surgical removal of the breast (mastectomy) is for not less than 48 hours of Inpatient care following a mastectomy and not less than 24 hours of Inpatient care following a lymph node dissection for the treatment of breast cancer, unless you and the attending Practitioner/Provider determine that a shorter period of Hospital stay is appropriate. o Coverage for minimum Hospital stays for mastectomies and lymph node dissections for the treatment of breast cancer is subject to Cost Sharing amounts consistent with those imposed on other benefits. Refer to your Maternity and delivery section of your Summary of Benefits and Coverage for Cost Sharing amounts. o Coverage is provided for external breast prostheses following Medically Necessary surgical removal of the breast (mastectomy). Two bras per year are Covered for Members with external breast prosthesis. o As an alternative, post mastectomy reconstructive breast surgery is provided, including nipple reconstruction and/or tattooing, tram flap (or breast implant if necessary), and reconstruction of the opposite breast, if necessary, to produce symmetrical appearance. o Prostheses and treatment for physical complications of mastectomy, including lymphedema are Covered at all stages of mastectomy. • Osteoporosis Coverage for services related to the treatment and appropriate management of osteoporosis when such services are determined to be Medically Necessary. • The Alpha-fetoprotein IV screening test for pregnant women, generally between 16 and 20 weeks for pregnancy, to screen for certain genetic abnormalities in the fetus. • Non-Invasive Prenatal Testing (NIPT) (may require Prior Authorization). • Coverage for the preventive screening of women who have family members with breast, ovarian, tubal or peritoneal cancers with one of several screening tools designed to identify a family history that may be associated with an increased risk for potentially harmful mutations in breast cancer susceptibility genes (BRCA 1 or BRCA 2) (may require Prior Authorization). • Women with positive screening results may receive genetic counseling and, if indicated after counseling, BRCA testing as determined by her healthcare Provider (may require Prior Authorization).