Pregnancy Services and Nursery Care. If you are covered as an individual under this agreement you must notify your employer and pay the appropriate family membership fee within thirty (30) days of delivery so that the newborn child will be covered beyond such thirty (30) day period. This agreement does not cover services for a newborn child who remains hospitalized after thirty (30) days and has not been added to a family membership. See Section 2.2 - When Your Coverage Begins - Special Enrollment. connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a delivery by cesarean section. However, the plan or issuer may pay for a shorter stay if the attending provider (e.g., your physician, nurse midwife, or physician assistant), after consultation with the mother, discharges the mother or newborn earlier. Also, under federal law, plans and issuers may not set the level of benefits or out-of-pocket costs so that any later portion of the 48-hour (or 96-hour) stay is treated in a manner less favorable to the mother or newborn than any earlier portion of the stay. In addition, a plan or issuer may not, under federal law, require that a physician or other health care provider obtain authorization for prescribing a length of stay of up to 48 hours (or 96 hours).
Appears in 5 contracts
Samples: Subscriber Agreement, Subscriber Agreement, Subscriber Agreement
