Number of Hospital Days Covered. Provided the conditions, including the requirements below, are met and continue to be met, as determined by CareFirst, hospital benefits for inpatient hospital services will be provided as follows: A. Hospitalization for Rehabilitation Benefits are provided for an admission or transfer to a CareFirst approved facility for rehabilitation. Benefits provided during any admission will not exceed any applicable benefit limitation. The limit, if any, on hospitalization for rehabilitation applies to any portion of an admission that: 1. Is required primarily for Physical Therapy or other rehabilitative care; and 2. Would not be Medically Necessary based solely on the Member's need for inpatient acute care services other than for rehabilitation. B. Inpatient Coverage Following a Mastectomy Coverage will be provided for a minimum hospital stay of not less than: 1. Forty-eight (48) hours following a radical or modified radical Mastectomy; and 2. Twenty-four (24) hours following a partial Mastectomy with lymph node dissection. In consultation with the Member’s attending physician, the Member may elect to stay less than the minimum prescribed above when appropriate. C. Hysterectomies Coverage will be provided for vaginal hysterectomies and abdominal hysterectomies. Coverage includes a minimum stay in the hospital of: SAMPLE 1. Not less than twenty-three (23) hours for a laparoscopy-assisted vaginal hysterectomy; and 2. Not less than forty-eight (48) hours for a vaginal hysterectomy. In consultation with the Member’s attending physician, the Member may elect to stay less than the minimum prescribed above when appropriate. D. Childbirth Coverage will be provided for a minimum hospital stay of not less than: 1. Forty-eight (48) hours for both the mother and newborn following a routine vaginal delivery; 2. Ninety-six (96) hours for both the mother and newborn following a routine cesarean section. Prior authorization is not required for maternity admissions. Whenever a mother is required to remain hospitalized after childbirth for medical reasons and the mother requests that the newborn remain in the hospital, coverage includes additional hospitalization for the newborn for up to four (4) days. If the delivery occurs in the hospital, the length of stay begins at the time of the delivery. If the delivery occurs outside of the hospital, the length of stay begins upon admission to the hospital. The Member and the attending physician may agree to an early discharge. Non-routine care of the newborn, either during or following the mother’s covered hospitalization, requires that the newborn be covered as a Member in the newborn’s own right. Section 2.6 of the Agreement describes the steps, if any, necessary to enroll a newborn Dependent child.
Appears in 4 contracts
Samples: Individual Enrollment Agreement for a Qualified Health Plan, Individual Enrollment Agreement for a Qualified Health Plan, Individual Enrollment Agreement for a Qualified Health Plan
Number of Hospital Days Covered. Provided the conditions, including the requirements below, are met and continue to be met, as determined by CareFirstCareFirst BlueChoice, hospital benefits for inpatient hospital services Inpatient Hospital Services will be provided as follows:
A. Hospitalization for Rehabilitation Benefits are provided for an admission or transfer to a CareFirst approved facility for rehabilitation. Benefits provided during any admission will not exceed any applicable benefit limitation. The limit, if any, on hospitalization for rehabilitation applies to any portion of an admission that:
1. Is required primarily for Physical Therapy or other rehabilitative care; and
2. Would not be Medically Necessary based solely on the Member's need for inpatient acute care services other than for rehabilitation.
B. Inpatient Coverage Following a Mastectomy Mastectomy. Coverage will be provided for a minimum hospital stay of not less than:
1. Forty-eight (48) hours following a radical or modified radical Mastectomy; and
2. Twenty-four (24) hours following a partial Mastectomy with lymph node dissection. In consultation with the Member’s attending physician, the Member may elect to stay less than the minimum prescribed above when appropriate.
C. Hysterectomies B. Hysterectomies. Coverage will be provided for vaginal hysterectomies and abdominal hysterectomies. Coverage includes a minimum stay in the hospital of: SAMPLE
1. Not less than twenty-three (23) hours for a laparoscopy-assisted vaginal hysterectomy; and
2. Not less than forty-eight (48) hours for a vaginal hysterectomy. In consultation with the Member’s attending physicianhealth care provider, the Member may elect to stay less than the minimum prescribed above when appropriate.
D. Childbirth C. Childbirth. Coverage will be provided for a minimum hospital stay of not less than:
1. Forty-eight (48) hours for both the mother and newborn following a routine vaginal delivery;; and
2. Ninety-six (96) hours for both the mother and newborn following a routine cesarean section. Prior authorization is not required for maternity admissions. Whenever a mother is required to remain hospitalized after childbirth for medical reasons and the mother requests that the newborn remain in the hospital, coverage includes additional hospitalization for the newborn for up to four (4) days. If the delivery occurs in the hospital, the length of stay begins at the time of the delivery. If the delivery occurs outside of the hospital, hospital the length of stay begins upon admission to the hospital. The Member and the attending physician provider may agree to an early discharge. Non-routine care of the newborn, either during or following the mother’s covered hospitalization, requires that the newborn be covered as a Member in the newborn’s own right. Section 2.6 of the Individual Enrollment Agreement describes the steps, if any, necessary to enroll a newborn Dependent childChild. This section is not applicable to a Child- Only Agreement.
Appears in 4 contracts
Samples: Individual Enrollment Agreement for a Qualified Health Plan, Individual Enrollment Agreement for a Qualified Health Plan, Individual Enrollment Agreement
Number of Hospital Days Covered. Provided the conditions, including the requirements below, are met and continue to be met, as determined by CareFirstCareFirst BlueChoice, hospital benefits for inpatient hospital services will be provided as follows:
A. Hospitalization for Rehabilitation Rehabilitation Benefits are provided for an admission or transfer to a CareFirst BlueChoice approved facility for rehabilitation. Benefits provided during any admission will not exceed any applicable benefit limitation. The limit, if any, on hospitalization for rehabilitation applies to any portion of an admission that:
1. Is required primarily for Physical Therapy or other rehabilitative care; and
2. Would not be Medically Necessary based solely on the Member's need for inpatient acute care services other than for rehabilitation.
B. Inpatient Coverage Following a Mastectomy Coverage will be provided for a minimum hospital stay of not less than:
1. Forty-eight (48) hours following a radical or modified radical Mastectomy; andand SAMPLE
2. Twenty-four (24) hours following a partial Mastectomy with lymph node dissection. In consultation with the Member’s attending physicianContracting Physician, the Member may elect to stay less than the minimum prescribed above when appropriate.
C. Hysterectomies Coverage will be provided for vaginal hysterectomies and abdominal hysterectomies. Coverage includes a minimum stay in the hospital of: SAMPLE:
1. Not less than twenty-three (23) hours for a laparoscopy-assisted vaginal hysterectomy; and
2. Not less than forty-eight (48) hours for a vaginal hysterectomy. In consultation with the Member’s attending physicianContracting Physician, the Member may elect to stay less than the minimum prescribed above when appropriate.
D. Childbirth Coverage will be provided for a minimum hospital stay of not less than:
1. Forty-eight (48) hours for both the mother and newborn following a routine vaginal delivery;
2. Ninety-six (96) hours for both the mother and newborn following a routine cesarean section. Prior authorization is not required for maternity admissions. Whenever a mother is required to remain hospitalized after childbirth for medical reasons and the mother requests that the newborn remain in the hospital, coverage includes additional hospitalization for the newborn for up to four (4) days. If the delivery occurs in the hospital, the length of stay begins at the time of the delivery. If the delivery occurs outside of the hospital, the length of stay begins upon admission to the hospital. The Member and the attending physician Contracting Provider may agree to an early discharge. Non-routine care of the newborn, either during or following the mother’s covered hospitalization, requires that the newborn be covered as a Member in the newborn’s own right. Section 2.6 of the The Agreement describes the steps, if any, necessary to enroll a newborn Dependent child.
Appears in 4 contracts
Samples: Individual Enrollment Agreement for a Qualified Health Plan, Individual Enrollment Agreement, Individual Enrollment Agreement for a Qualified Health Plan
Number of Hospital Days Covered. Provided the conditions, including the requirements below, are met and continue to be met, as determined by CareFirstCareFirst BlueChoice, hospital benefits for inpatient hospital services will be provided as follows:
A. Hospitalization for Rehabilitation Benefits are provided for an admission or transfer to a CareFirst BlueChoice approved facility for rehabilitation. Benefits provided during any admission will not exceed any applicable benefit limitation. The limit, if any, on hospitalization for rehabilitation applies to any portion of an admission that:
1. Is required primarily for Physical Therapy or other rehabilitative care; and
2. Would not be Medically Necessary based solely on the Member's need for inpatient acute care services other than for rehabilitation.
B. Inpatient Coverage Following a Mastectomy Coverage will be provided for a minimum hospital stay of not less than:
1. Forty-eight (48) hours following a radical or modified radical Mastectomy; and
2. Twenty-four (24) hours following a partial Mastectomy with lymph node dissection. SAMPLE In consultation with the Member’s attending physicianContracting Physician, the Member may elect to stay less than the minimum prescribed above when appropriate.
C. Hysterectomies Coverage will be provided for vaginal hysterectomies and abdominal hysterectomies. Coverage includes a minimum stay in the hospital of: SAMPLE:
1. Not less than twenty-three (23) hours for a laparoscopy-assisted vaginal hysterectomy; and
2. Not less than forty-eight (48) hours for a vaginal hysterectomy. In consultation with the Member’s attending physicianContracting Physician, the Member may elect to stay less than the minimum prescribed above when appropriate.
D. Childbirth Coverage will be provided for a minimum hospital stay of not less than:
1. Forty-eight (48) hours for both the mother and newborn following a routine vaginal delivery;
2. Ninety-six (96) hours for both the mother and newborn following a routine cesarean section. Prior authorization is not required for maternity admissions. Whenever a mother is required to remain hospitalized after childbirth for medical reasons and the mother requests that the newborn remain in the hospital, coverage includes additional hospitalization for the newborn for up to four (4) days. If the delivery occurs in the hospital, the length of stay begins at the time of the delivery. If the delivery occurs outside of the hospital, the length of stay begins upon admission to the hospital. The Member and the attending physician Contracting Provider may agree to an early discharge. Non-routine care of the newborn, either during or following the mother’s covered hospitalization, requires that the newborn be covered as a Member in the newborn’s own right. Section 2.6 of the The Agreement describes the steps, if any, necessary to enroll a newborn Dependent child.
Appears in 3 contracts
Samples: Individual Enrollment Agreement, Individual Enrollment Agreement for a Qualified Health Plan, Individual Enrollment Agreement for a Qualified Health Plan
Number of Hospital Days Covered. Provided the conditions, including the requirements below, are met and continue to be met, as determined by CareFirst, hospital benefits for inpatient hospital services Inpatient Hospital Services will be provided as follows:
A. Hospitalization for Rehabilitation Rehabilitation Benefits are provided for an admission or transfer to a CareFirst approved facility for rehabilitation. Benefits provided during any admission confinement will not exceed any applicable the benefit limitation. The limit, if any, stated in the Schedule of Benefits. As used in this paragraph, a confinement means a continuous period of hospitalization or two or more admissions separated by thirty (30) days. This limit on hospitalization for rehabilitation applies to any portion of an admission that:
1. Is required primarily for Physical Therapy or other rehabilitative care; and
2. Would not be Medically Necessary based solely on the Member's need for inpatient acute care services other than for rehabilitation.
B. Inpatient Coverage Following a Mastectomy Coverage will be provided for a minimum hospital stay of not less than:
1. Forty-eight (48) hours following a radical or modified radical Mastectomy; and
2. Twenty-four (24) hours following a partial Mastectomy with lymph node dissection. In consultation with dissection for the Member’s attending physician, the Member may elect to stay less than the minimum prescribed above when appropriatetreatment of breast cancer.
C. Hysterectomies Coverage will be provided for vaginal hysterectomies and abdominal laparoscopy- assisted vaginal hysterectomies. Coverage includes a minimum stay in the hospital of: SAMPLE:
1. Not less than twenty-three (23) hours for a laparoscopy-assisted vaginal hysterectomy; and
2. Not less than forty-eight (48) hours for a vaginal hysterectomy. In consultation with the Member’s attending physicianHealth Care Practitioner, the Member may elect to stay less than the minimum prescribed above when appropriate.
D. Childbirth Coverage will be provided for a minimum hospital stay of not less than:
1. Forty-eight (48) hours for both the mother and newborn following a routine vaginal delivery;
2. Ninety-six (96) hours for both the mother and newborn following a routine cesarean section. Prior authorization is not required for maternity admissions. Whenever a mother is required to remain hospitalized after childbirth for medical reasons and the mother requests that the newborn remain in the hospital, coverage includes additional hospitalization for the newborn for up to four (4) daysminimum hospital stays listed above. If the delivery occurs in the hospital, the length of stay begins at the time of the delivery. If the delivery occurs outside of the hospital, hospital the length of stay begins upon admission to the hospital. The Member and the attending physician Health Care Practitioner may agree to an early discharge. Non-routine care of the newborn, either during or following the mother’s covered hospitalization, requires that the newborn be covered as a Member in the newborn’s own right. Section 2.6 of the Agreement describes the steps, if any, necessary to enroll a newborn Dependent child.
Appears in 2 contracts
Samples: Member Contract, Member Contract
Number of Hospital Days Covered. Provided the conditions, including the requirements below, are met and continue to be met, as determined by CareFirst, hospital benefits for inpatient hospital services Inpatient Hospital Services will be provided as follows:
A. Hospitalization for Rehabilitation Benefits are provided for an admission or transfer to a CareFirst approved facility for rehabilitation. Benefits provided during any admission will not exceed any applicable benefit limitation. The limit, if any, on hospitalization for rehabilitation applies to any portion of an admission that:
1. Is required primarily for Physical Therapy or other rehabilitative care; and
2. Would not be Medically Necessary based solely on the Member's need for inpatient acute care services other than for rehabilitation.
B. Inpatient Coverage Following a Mastectomy Mastectomy. Coverage will be provided for a minimum hospital stay of not less than:
1. Forty-eight (48) hours following a radical or modified radical Mastectomy; and
2. Twenty-four (24) hours following a partial Mastectomy with lymph node dissection. In consultation with the Member’s 's attending physician, the Member may elect to stay less than the minimum prescribed above when appropriate.
C. Hysterectomies B. Hysterectomies. Coverage will be provided for vaginal hysterectomies and abdominal hysterectomies. Coverage includes a minimum stay in the hospital of: SAMPLE
1. Not less than twenty-three (23) hours for a laparoscopy-assisted vaginal hysterectomy; and
2. Not less than forty-eight (48) hours for a vaginal hysterectomy. In consultation with the Member’s attending physicianhealth care provider, the Member may elect to stay less than the minimum prescribed above when appropriate.
D. Childbirth C. Childbirth. Coverage will be provided for a minimum hospital stay of not less than:
1. Forty-eight (48) hours for both the mother and newborn following a routine vaginal delivery;
2. Ninety-six (96) hours for both the mother and newborn following a routine cesarean section. Prior authorization is not required for maternity admissions. Whenever a mother is required to remain hospitalized after childbirth for medical reasons and the mother requests that the newborn remain in the hospital, coverage includes additional hospitalization for the newborn for up to four (4) days. If the delivery occurs in the hospital, the length of stay begins at the time of the delivery. If the delivery occurs outside of the hospital, hospital the length of stay begins upon admission to the hospital. The Member and the attending physician provider may agree to an early discharge. Non-routine care of the newborn, either during or following the mother’s 's covered hospitalization, requires that the newborn be covered as a Member in the newborn’s 's own right. Section 2.6 of in the Individual Enrollment Agreement describes the steps, if any, necessary to enroll a newborn Dependent childChild. The non-routine care of the newborn is not applicable to a Child-Only Agreement.
Appears in 1 contract
Samples: Student Health Plan Individual Enrollment Agreement
Number of Hospital Days Covered. Provided the conditions, including the requirements below, are met and continue to be met, as determined by CareFirstCareFirst BlueChoice, hospital benefits for inpatient hospital services Inpatient Hospital Services will be provided as follows:
A. Hospitalization for Rehabilitation Benefits are provided for an admission or transfer to a CareFirst approved facility for rehabilitation. Benefits provided during any admission will not exceed any applicable benefit limitation. The limit, if any, on hospitalization for rehabilitation applies to any portion of an admission that:
1. Is required primarily for Physical Therapy or other rehabilitative care; and
2. Would not be Medically Necessary based solely on the Member's need for inpatient acute care services other than for rehabilitation.
B. Inpatient Coverage Following a Mastectomy Coverage will be provided for a minimum hospital stay of not less than:
1. Forty-eight (48) hours following a radical or modified radical Mastectomy; and
2. Twenty-four (24) hours following a partial Mastectomy with lymph node dissection. In consultation with the Member’s attending physician, the Member may elect to stay less than the minimum prescribed above when appropriate.
C. Hysterectomies B. Hysterectomies. Coverage will be provided for vaginal hysterectomies and abdominal hysterectomies. Coverage includes a minimum stay in the hospital of: SAMPLE:
1. Not less than twenty-three (23) hours for a laparoscopy-assisted vaginal hysterectomy; andand SAMPLE
2. Not less than forty-eight (48) hours for a vaginal hysterectomy. In consultation with the Member’s attending physicianhealth care provider, the Member may elect to stay less than the minimum prescribed above when appropriate.
D. Childbirth C. Childbirth. Coverage will be provided for a minimum hospital stay of not less than:
1. Forty-eight (48) hours for both the mother and newborn following a routine vaginal delivery;
2. Ninety-six (96) hours for both the mother and newborn following a routine cesarean section. Prior authorization is not required for maternity admissions. Whenever a mother is required to remain hospitalized after childbirth for medical reasons and the mother requests that the newborn remain in the hospital, coverage includes additional hospitalization for the newborn for up to four (4) days. If the delivery occurs in the hospital, the length of stay begins at the time of the delivery. If the delivery occurs outside of the hospital, hospital the length of stay begins upon admission to the hospital. The Member and the attending physician provider may agree to an early discharge. Non-routine care of the newborn, either during or following the mother’s covered hospitalization, requires that the newborn be covered as a Member in the newborn’s own right. Section 2.6 of the In-Network Individual Enrollment Agreement describes the steps, if any, necessary to enroll a newborn Dependent childChild. This section is not applicable to a Child-Only Agreement.
Appears in 1 contract
Number of Hospital Days Covered. Provided the conditions, including the requirements below, are met and continue to be met, as determined by CareFirstCareFirst BlueChoice, hospital benefits for inpatient hospital services will be provided as follows:
A. Hospitalization for Rehabilitation Benefits are provided for an admission or transfer to a CareFirst BlueChoice approved facility for rehabilitation. Benefits provided during any admission will not exceed any applicable benefit limitation. The limit, if any, on hospitalization for rehabilitation applies to any portion of an admission that:
1. Is required primarily for Physical Therapy or other rehabilitative care; and
2. Would not be Medically Necessary based solely on the Member's need for inpatient acute care services other than for rehabilitation.
B. Inpatient Coverage Following a Mastectomy Coverage will be provided for a minimum hospital stay of not less than:
1. Forty-eight (48) hours following a radical or modified radical Mastectomy; and
2. Twenty-four (24) hours following a partial Mastectomy with lymph node dissection. In consultation with the Member’s attending physicianContracting Physician, the Member may elect to stay less than the minimum prescribed above when appropriate.
C. Hysterectomies Coverage will be provided for vaginal hysterectomies and abdominal hysterectomies. Coverage includes a minimum stay in the hospital of: SAMPLE:
1. Not less than twenty-three (23) hours for a laparoscopy-assisted vaginal hysterectomy; and
2. Not less than forty-eight (48) hours for a vaginal hysterectomy. In consultation with the Member’s attending physicianContracting Physician, the Member may elect to stay less than the minimum prescribed above when appropriate.
D. Childbirth Coverage will be provided for a minimum hospital stay of not less than:
1. Forty-eight (48) hours for both the mother and newborn following a routine vaginal delivery;
2. Ninety-six (96) hours for both the mother and newborn following a routine cesarean section. Prior authorization is not required for maternity admissions. Whenever a mother is required to remain hospitalized after childbirth for medical reasons and the mother requests that the newborn remain in the hospital, coverage includes additional hospitalization for the newborn for up to four (4) days. If the delivery occurs in the hospital, the length of stay begins at the time of the delivery. If the delivery occurs outside of the hospital, the length of stay begins upon admission to the hospital. The Member and the attending physician Contracting Provider may agree to an early discharge. Non-routine care of the newborn, either during or following the mother’s covered hospitalization, requires that the newborn be covered as a Member in the newborn’s own right. Section 2.6 of the The Agreement describes the steps, if any, necessary to enroll a newborn Dependent child.
Appears in 1 contract
Samples: Individual Enrollment Agreement
Number of Hospital Days Covered. Provided the conditions, including the requirements below, are met and continue to be met, as determined by CareFirst, hospital benefits for inpatient hospital services Inpatient Hospital Services will be provided as follows:
A. Hospitalization for Rehabilitation Benefits are provided for an admission or transfer to a CareFirst approved facility for rehabilitation. Benefits provided during any admission will not exceed any applicable benefit limitation. The limit, if any, on hospitalization for rehabilitation applies to any portion of an admission that:
1. Is required primarily for Physical Therapy or other rehabilitative care; and
2. Would not be Medically Necessary based solely on the Member's need for inpatient acute care services other than for rehabilitation.
B. Inpatient Coverage Following a Mastectomy Mastectomy. Coverage will be provided for a minimum hospital stay of not less than:
1. Forty-eight (48) hours following a radical or modified radical Mastectomy; and
2. Twenty-four (24) hours following a partial Mastectomy with lymph node dissection. In consultation with the Member’s 's attending physician, the Member may elect to stay less than the minimum prescribed above when appropriate.
C. Hysterectomies B. Hysterectomies. Coverage will be provided for vaginal hysterectomies and abdominal hysterectomies. Coverage includes a minimum stay in the hospital of: SAMPLE:
1. Not less than twenty-three (23) hours for a laparoscopy-assisted vaginal hysterectomy; and
2. Not less than forty-eight (48) hours for a vaginal hysterectomy. In consultation with the Member’s attending physicianhealth care provider, the Member may elect to stay less than the minimum prescribed above when appropriate.
D. Childbirth C. Childbirth. Coverage will be provided for a minimum hospital stay of not less than:
1. Forty-eight (48) hours for both the mother and newborn following a routine vaginal delivery;
2. Ninety-six (96) hours for both the mother and newborn following a routine cesarean section. Prior authorization is not required for maternity admissions. Whenever a mother is required to remain hospitalized after childbirth for medical reasons and the mother requests that the newborn remain in the hospital, coverage includes additional hospitalization for the newborn for up to four (4) days. If the delivery occurs in the hospital, the length of stay begins at the time of the delivery. If the delivery occurs outside of the hospital, hospital the length of stay begins upon admission to the hospital. The Member and the attending physician provider may agree to an early discharge. Non-routine care of the newborn, either during or following the mother’s 's covered hospitalization, requires that the newborn be covered as a Member in the newborn’s 's own right. Section 2.6 of in the Individual Enrollment Agreement describes the steps, if any, necessary to enroll a newborn Dependent childChild. The non-routine care of the newborn is not applicable to a Child-Only Agreement.
Appears in 1 contract
Samples: Student Health Plan Individual Enrollment Agreement
Number of Hospital Days Covered. Provided the conditions, including the requirements below, are met and continue to be met, as determined by CareFirstCareFirst BlueChoice, hospital benefits for inpatient hospital services will be provided as follows:
A. Hospitalization for Rehabilitation Benefits are provided for an admission or transfer to a CareFirst BlueChoice approved facility for rehabilitation. Benefits provided during any admission will not exceed any applicable benefit limitation. The limit, if any, on hospitalization for rehabilitation applies to any portion of an admission that:
1. Is required primarily for Physical Therapy or other rehabilitative care; and
2. Would not be Medically Necessary based solely on the Member's need for inpatient acute care services other than for rehabilitation.
B. Inpatient Coverage Following a Mastectomy Coverage will be provided for a minimum hospital stay of not less than:
1. Forty-eight (48) hours following a radical or modified radical Mastectomy; and
2. Twenty-four (24) hours following a partial Mastectomy with lymph node dissection. Sample In consultation with the Member’s attending physicianContracting Physician, the Member may elect to stay less than the minimum prescribed above when appropriate.
C. Hysterectomies Coverage will be provided for vaginal hysterectomies and abdominal hysterectomies. Coverage includes a minimum stay in the hospital of: SAMPLE:
1. Not less than twenty-three (23) hours for a laparoscopy-assisted vaginal hysterectomy; and
2. Not less than forty-eight (48) hours for a vaginal hysterectomy. In consultation with the Member’s attending physicianContracting Physician, the Member may elect to stay less than the minimum prescribed above when appropriate.
D. Childbirth Coverage will be provided for a minimum hospital stay of not less than:
1. Forty-eight (48) hours for both the mother and newborn following a routine vaginal delivery;
2. Ninety-six (96) hours for both the mother and newborn following a routine cesarean section. Prior authorization is not required for maternity admissions. Whenever a mother is required to remain hospitalized after childbirth for medical reasons and the mother requests that the newborn remain in the hospital, coverage includes additional hospitalization for the newborn for up to four (4) days. If the delivery occurs in the hospital, the length of stay begins at the time of the delivery. If the delivery occurs outside of the hospital, the length of stay begins upon admission to the hospital. The Member and the attending physician Contracting Provider may agree to an early discharge. Non-routine care of the newborn, either during or following the mother’s covered hospitalization, requires that the newborn be covered as a Member in the newborn’s own right. Section 2.6 of the The Agreement describes the steps, if any, necessary to enroll a newborn Dependent child.
Appears in 1 contract
Samples: Individual Enrollment Agreement for a Qualified Health Plan