Common use of Newborn Care Clause in Contracts

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.