Common use of Women’s Healthcare Clause in Contracts

Women’s Healthcare. This benefit has one or more exclusions as specified in the Exclusions Section. The following Woman’s Healthcare Services, in addition to services listed in the Preventive Care Section are available for our female Members under the Women’s Health and Cancer Rights Act (WHCRA). Inpatient Hospital services require Prior Authorization. Obstetrical/Gynecological care includes: • Annual exams • Care related to pregnancy • Miscarriage • Therapeutic abortions • Elective abortions up to 24 weeks • Other obstetrical/gynecological services Prenatal Maternity care benefits include: • Prenatal care • Pregnancy related diagnostic tests, (including an alpha-fetoprotein IV screening test, generally between 16 and 20 weeks of pregnancy, to screen for certain abnormalities in the fetus) • Visits to an Obstetrician • Certified Nurse-midwife • Licensed Midwife • Medically Necessary nutritional supplements as determined and prescribed by the attending Practitioner/Provider. Prescription nutritional supplements require Prior Authorization. • Childbirth in a Hospital or in a licensed birthing center Maternity Care In Accordance with the Newborns’ and Mothers’ Health Protection Act (the Newborns’ Act), the following benefits are Covered: • Maternity Coverage is available to a mother and her newborn (if 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. Maternity In-patient Hospital admissions and birthing center admissions require notification to appropriately manage care. Your provider will provide notification to the Health Plan of your maternity admission. Please see coverage for emergent/prior authorization admissions. • In the event that the mother requests an earlier discharge, a mutual agreement must be reached between the mother and her attending Practitioner/Provider. Such discharge must be made in accordance with the medical criteria outlined in the most current version of the “Guidelines for Prenatal Care” prepared by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists including, but not limited to, the criterion that family Members or other support person(s) will be available to the mother for the first few days following early discharge. • Maternity Inpatient care in excess of 48 hours following a vaginal delivery and 96 hours following a cesarean section will be Covered if determined to be Medically Necessary by the mother’s attending Practitioner/Provider. An additional stay will be considered a separate Hospital stay and requires Prior Authorization. Refer to your Summary of Benefits and Coverage for Cost Sharing information. • High-risk Ambulance services are Covered in accordance with the Ambulance Services Benefits Section. • The services of a Licensed Midwife or Certified Nurse Midwife are Covered, for the following: o The midwife’s services must be provided strictly according to their legal scope of practice and in accordance with all applicable state licensing regulations which may include a supervisory component. o The services must be provided in preparation for or in connection with the delivery of a newborn. o For purpose of Coverage under this Agreement, the only allowable sites of delivery are a Hospital or a licensed birthing center. Elective Home Births and any prenatal or postpartum services connected with Elective Home Births are not Covered. Elective Home Birth means a birth that was planned or intended by the Member or Practitioner/Provider to occur in the home. o The combined fees of the midwife and any attending or supervising Practitioners/Providers, for all services provided before, during and after the birth, may not exceed the allowable fee(s) that would have been payable to the Practitioner/Provider had he/she been the sole Practitioner/Provider of those services.‌

Women’s Healthcare. This benefit has one or more exclusions as specified in the Exclusions Section. The following Woman’s Healthcare Services, in addition to services listed in the Preventive Care Section and other Sections of this Agreement are available for our female Members under the Women’s Health and Cancer Rights Act (WHCRA). Inpatient Hospital services require Prior Authorization. Obstetrical/Gynecological care includes: • · Annual exams • · Care related to pregnancy • · Miscarriage • · Therapeutic abortions • · Elective abortions up to 24 weeks • · Other obstetrical/gynecological services Prenatal Maternity care benefits include: • · Prenatal care • · Pregnancy related diagnostic tests, (including an alpha-fetoprotein IV screening test, generally between 16 and 20 weeks of pregnancy, to screen for certain abnormalities in the fetus) • · Visits to an Obstetrician • · Certified Nurse-midwife • · Licensed Midwife • · Medically Necessary nutritional supplements as determined and prescribed by the attending Practitioner/Provider. Prescription nutritional supplements require Prior Authorization. • · Childbirth in a Hospital or in a licensed birthing center Maternity Care In Accordance with the Newborns’ and Mothers’ Health Protection Act (the Newborns’ Act), the following benefits services are Coveredavailable: • · Maternity Coverage is available to a mother and her newborn (if 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. Maternity In-patient Hospital admissions and birthing center admissions require notification to appropriately manage care. Your provider will provide notification to the Health Plan of your maternity admission. Please see coverage for emergent/prior authorization Prior Authorization admissions. • · In the event that the mother requests an earlier discharge, a mutual agreement must be reached between the mother and her attending Practitioner/Provider. Such discharge must be made in accordance with the medical criteria outlined in the most current version of the “Guidelines for Prenatal Care” prepared by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists including, but not limited to, the criterion that family Members or other support person(s) will be available to the mother for the first few days following early discharge. • · Maternity Inpatient care in excess of 48 hours following a vaginal delivery and 96 hours following a cesarean section will be Covered if determined to be Medically Necessary by the mother’s attending Practitioner/Provider. An additional stay will be considered a separate Hospital stay and requires Prior Authorization. Refer to your Summary of Benefits and Coverage for Cost Cost-Sharing information. • · High-risk Ambulance services are Covered in accordance with the Ambulance Services Benefits Section. • · The services of a Licensed Midwife or Certified Nurse Midwife are Covered, for the following: o The midwife’s services must be provided strictly according to their legal scope of practice and in accordance with all applicable state licensing regulations which may include a supervisory component. o The services must be provided in preparation for or in connection with the delivery of a newborn. o For purpose of Coverage under this Agreement, the only allowable sites of delivery are a Hospital or a licensed birthing center. Elective Home Births and any prenatal or postpartum services connected with Elective Home Births are not Covered. Elective Home Birth means a birth that was planned or intended by the Member or Practitioner/Provider to occur in the home. o The combined fees of the midwife and any attending or supervising Practitioners/Providers, for all services provided before, during and after the birth, may not exceed the allowable fee(s) that would have been payable to the Practitioner/Provider had he/she been the sole Practitioner/Provider of those services.‌services.

Women’s Healthcare. This benefit has one or more exclusions as specified in the Exclusions Section. The following Woman’s Healthcare Services, in addition to services listed in the Preventive Care Section and other Sections of this Agreement are available for our female Members under the Women’s Health and Cancer Rights Act (WHCRA). Inpatient Hospital services require Prior Authorization. Obstetrical/Gynecological care includes: • Annual exams • Care related to pregnancy • Miscarriage • Therapeutic abortions • Elective abortions up to 24 weeks • Other obstetrical/gynecological services Prenatal Maternity care benefits include: • Prenatal care • Pregnancy related diagnostic tests, (including an alpha-fetoprotein IV screening test, generally between 16 sixteen and 20 twenty weeks of pregnancy, to screen for certain abnormalities in the fetus) • Visits to an Obstetrician • Certified Nurse-midwife • Licensed Midwife • Medically Necessary nutritional supplements as determined and prescribed by the attending Practitioner/Provider. Prescription nutritional supplements require Prior Authorization. • Childbirth in a Hospital or in a licensed birthing center Maternity Care In Accordance with the Newborns’ and Mothers’ Health Protection Act (the Newborns’ Act), the following benefits services are Coveredavailable: • Maternity Coverage is available to a mother and her newborn (if 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. Maternity In-patient Hospital admissions and birthing center admissions require notification to appropriately manage care. Your provider will provide notification to the Health Plan of your maternity admission. Please see coverage for emergent/prior authorization admissions. • In the event that the mother requests an earlier discharge, a mutual agreement must be reached between the mother and her attending Practitioner/Provider. Such discharge must be made in accordance with the medical criteria outlined in the most current version of the “Guidelines for Prenatal Care” prepared by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists including, but not limited to, the criterion that family Members or other support person(s) will be available to the mother for the first few days following early discharge. • Maternity Inpatient care in excess of 48 hours following a vaginal delivery and 96 hours following a cesarean section will be Covered if determined to be Medically Necessary by the mother’s attending Practitioner/Provider. An additional stay will be considered a separate Hospital stay and requires Prior Authorization. Refer to your Summary of Benefits and Coverage for Cost Sharing information. • High-risk Ambulance services are Covered in accordance with the Ambulance Services Benefits Section. • The services of a Licensed Midwife or Certified Nurse Midwife are Covered, for the following: o The midwife’s services must be provided strictly according to their legal scope of practice and in accordance with all applicable state licensing regulations which may include a supervisory component. o The services must be provided in preparation for or in connection with the delivery of a newborn. o For purpose of Coverage under this Agreement, the only allowable sites of delivery are a Hospital or a licensed birthing center. Elective Home Births and any prenatal or postpartum services connected with Elective Home Births are not Covered. Elective Home Birth means a birth that was planned or intended by the Member or Practitioner/Provider to occur in the home. o The combined fees of the midwife and any attending or supervising Practitioners/Providers, for all services provided before, during and after the birth, may not exceed the allowable fee(s) that would have been payable to the Practitioner/Provider had he/she been the sole Practitioner/Provider of those services.‌services. • Ultrasounds related to maternity care. Ultrasounds do not require prior authorization.

Women’s Healthcare. This benefit has one or more exclusions as specified in the Exclusions Section. The following Woman’s Healthcare Services, in addition to services listed in the Preventive Care Section and other Sections of this Agreement are available for our female Members under the Women’s Health and Cancer Rights Act (WHCRA). Inpatient Hospital services require Prior Authorization. Obstetrical/Gynecological care includes: • Annual exams • Care related to pregnancy • Miscarriage • Therapeutic abortions • Elective abortions up to 24 weeks • Other obstetrical/gynecological services Prenatal Maternity care benefits include: • Prenatal care • Pregnancy related diagnostic tests, (including an alpha-fetoprotein IV screening test, generally between 16 and 20 weeks of pregnancy, to screen for certain abnormalities in the fetus) • Visits to an Obstetrician • Certified Nurse-midwife • Licensed Midwife • Medically Necessary nutritional supplements as determined and prescribed by the attending Practitioner/Provider. Prescription nutritional supplements require Prior Authorization. • Childbirth in a Hospital or in a licensed birthing center Maternity Care In Accordance with the Newborns’ and Mothers’ Health Protection Act (the Newborns’ Act), the following benefits services are Coveredavailable: • Maternity Coverage is available to a mother and her newborn (if 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. Maternity In-patient Hospital admissions and birthing center admissions require notification to appropriately manage care. Your provider will provide notification to the Health Plan of your maternity admission. Please see coverage for emergent/prior authorization Prior Authorization admissions. • In the event that the mother requests an earlier discharge, a mutual agreement must be reached between the mother and her attending Practitioner/Provider. Such discharge must be made in accordance with the medical criteria outlined in the most current version of the “Guidelines for Prenatal Care” prepared by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists including, but not limited to, the criterion that family Members or other support person(s) will be available to the mother for the first few days following early discharge. • Maternity Inpatient care in excess of 48 hours following a vaginal delivery and 96 hours following a cesarean section will be Covered if determined to be Medically Necessary by the mother’s attending Practitioner/Provider. An additional stay will be considered a separate Hospital stay and requires Prior Authorization. Refer to your Summary of Benefits and Coverage for Cost Cost-Sharing information. • High-risk Ambulance services are Covered in accordance with the Ambulance Services Benefits Section. • The services of a Licensed Midwife or Certified Nurse Midwife are Covered, for the following: o The midwife’s services must be provided strictly according to their legal scope of practice and in accordance with all applicable state licensing regulations which may include a supervisory component. o The services must be provided in preparation for or in connection with the delivery of a newborn. o For purpose of Coverage under this Agreement, the only allowable sites of delivery are a Hospital or a licensed birthing center. Elective Home Births and any prenatal or postpartum services connected with Elective Home Births are not Covered. Elective Home Birth means a birth that was planned or intended by the Member or Practitioner/Provider to occur in the home. o The combined fees of the midwife and any attending or supervising Practitioners/Providers, for all services provided before, during and after the birth, may not exceed the allowable fee(s) that would have been payable to the Practitioner/Provider had he/she been the sole Practitioner/Provider of those services.‌services.

Women’s Healthcare. This benefit has one or more exclusions as specified in the Exclusions Section. The following Woman’s Healthcare Services, in addition to services listed in the Preventive Care Section and other Sections of this Agreement are available for our female Members under the Women’s Health and Cancer Rights Act (WHCRA). Inpatient Hospital services require Prior Authorization. Obstetrical/Gynecological care includes: • Annual exams • Care related to pregnancy • Miscarriage • Therapeutic abortions • Elective abortions up to 24 weeks • Other obstetrical/gynecological services Prenatal Maternity care benefits include: • Prenatal care • Pregnancy related diagnostic tests, (including an alpha-fetoprotein IV screening test, generally between 16 and 20 weeks of pregnancy, to screen for certain abnormalities in the fetus) • Visits to an Obstetrician • Certified Nurse-midwife • Licensed Midwife • Medically Necessary nutritional supplements as determined and prescribed by the attending Practitioner/Provider. Prescription nutritional supplements require Prior Authorization. • Childbirth in a Hospital or in a licensed birthing center Maternity Care In Accordance with the Newborns’ and Mothers’ Health Protection Act (the Newborns’ Act), the following benefits services are Coveredavailable: • Maternity Coverage is available to a mother and her newborn (if 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. Maternity In-patient Hospital admissions and birthing center admissions require notification to appropriately manage care. Your provider will provide notification to the Health Plan of your maternity admission. Please see coverage for emergent/prior authorization admissions. • In the event that the mother requests an earlier discharge, a mutual agreement must be reached between the mother and her attending Practitioner/Provider. Such discharge must be made in accordance with the medical criteria outlined in the most current version of the “Guidelines for Prenatal Care” prepared by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists including, but not limited to, the criterion that family Members or other support person(s) will be available to the mother for the first few days following early discharge. • Maternity Inpatient care in excess of 48 hours following a vaginal delivery and 96 hours following a cesarean section will be Covered if determined to be Medically Necessary by the mother’s attending Practitioner/Provider. An additional stay will be considered a separate Hospital stay and requires Prior Authorization. Refer to your Summary of Benefits and Coverage for Cost Sharing information. • High-risk Ambulance services are Covered in accordance with the Ambulance Services Benefits Section. • The services of a Licensed Midwife or Certified Nurse Midwife are Covered, for the following: o The midwife’s services must be provided strictly according to their legal scope of practice and in accordance with all applicable state licensing regulations which may include a supervisory component. o The services must be provided in preparation for or in connection with the delivery of a newborn. o For purpose of Coverage under this Agreement, the only allowable sites of delivery are a Hospital or a licensed birthing center. Elective Home Births and any prenatal or postpartum services connected with Elective Home Births are not Covered. Elective Home Birth means a birth that was planned or intended by the Member or Practitioner/Provider to occur in the home. o The combined fees of the midwife and any attending or supervising Practitioners/Providers, for all services provided before, during and after the birth, may not exceed the allowable fee(s) that would have been payable to the Practitioner/Provider had he/she been the sole Practitioner/Provider of those services.‌services.

Women’s Healthcare. This benefit has one or more exclusions as specified in the Exclusions Section. The following Woman’s Healthcare Services, in addition to services listed in the Preventive Care Section and other Sections of this Agreement are available for our female Members under the Women’s Health and Cancer Rights Act (WHCRA). Inpatient Hospital services require Prior Authorization. Obstetrical/Gynecological care includes: • Annual exams • Care related to pregnancy • Miscarriage • Therapeutic abortions • Elective abortions up to 24 weeks • Other obstetrical/gynecological services Prenatal Maternity care benefits include: • Prenatal care • Pregnancy related diagnostic tests, (including an alpha-fetoprotein IV screening test, generally between 16 and 20 weeks of pregnancy, to screen for certain abnormalities in the fetus) • Visits to an Obstetrician • Certified Nurse-midwife • Licensed Midwife • Medically Necessary nutritional supplements as determined and prescribed by the attending Practitioner/Provider. Prescription nutritional supplements require Prior Authorization. • Childbirth in a Hospital or in a licensed birthing center Maternity Care In Accordance with the Newborns’ and Mothers’ Health Protection Act (the Newborns’ Act), the following benefits services are Coveredavailable: • Maternity Coverage is available to a mother and her newborn (if 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. Maternity In-patient Hospital admissions and birthing center admissions require notification to appropriately manage care. Your provider will provide notification to the Health Plan of your maternity admission. Please see coverage for emergent/prior authorization Prior Authorization admissions. • In the event that the mother requests an earlier discharge, a mutual agreement must be reached between the mother and her attending Practitioner/Provider. Such discharge must be made in accordance with the medical criteria outlined in the most current version of the “Guidelines for Prenatal Care” prepared by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists including, but not limited to, the criterion that family Members or other support person(s) will be available to the mother for the first few days following early discharge. • Maternity Inpatient care in excess of 48 hours following a vaginal delivery and 96 hours following a cesarean section will be Covered if determined to be Medically Necessary by the mother’s attending Practitioner/Provider. An additional stay will be considered a separate Hospital stay and requires Prior Authorization. Refer to your Summary of Benefits and Coverage for Cost Cost-Sharing information. • High-risk Ambulance services are Covered in accordance with the Ambulance Services Benefits Section. • The services of a Licensed Midwife or Certified Nurse Midwife are Covered, for the following: o The midwife’s services must be provided strictly according to their legal scope of practice and in accordance with all applicable state licensing regulations which may include a supervisory component. o The services must be provided in preparation for or in connection with the delivery of a newborn. o For purpose of Coverage under this Agreement, the only allowable sites of delivery are a Hospital or a licensed birthing center. Elective Home Births and any prenatal or postpartum services connected with Elective Home Births are not Covered. Elective Home Birth means a birth that was planned or intended by the Member or Practitioner/Provider to occur in the home. home.‌ o The combined fees of the midwife and any attending or supervising Practitioners/Providers, for all services provided before, during and after the birth, may not exceed the allowable fee(s) that would have been payable to the Practitioner/Provider had he/she been the sole Practitioner/Provider of those services.‌services.

Women’s Healthcare. This benefit has one or more exclusions as specified in the Exclusions Section. The following Woman’s Healthcare Services, in addition to services listed in the Preventive Care Section and other Sections of this Agreement are available for our female Members under the Women’s Health and Cancer Rights Act (WHCRA). Inpatient Hospital services require Prior Authorization. Obstetrical/Gynecological care includes: • Annual exams • Care related to pregnancy • Miscarriage • Therapeutic abortions • Elective abortions up to 24 weeks • Other obstetrical/gynecological services Prenatal Maternity care benefits include: • Prenatal care • Pregnancy related diagnostic tests, (including an alpha-fetoprotein IV screening test, generally between 16 and 20 weeks of pregnancy, to screen for certain abnormalities in the fetus) • Visits to an Obstetrician • Certified Nurse-midwife • Licensed Midwife • Medically Necessary nutritional supplements as determined and prescribed by the attending Practitioner/Provider. Prescription nutritional supplements require Prior Authorization. • Childbirth in a Hospital or in a licensed birthing center Maternity Care In Accordance with the Newborns’ and Mothers’ Health Protection Act (the Newborns’ Act), the following benefits services are Coveredavailable: • Maternity Coverage is available to a mother and her newborn (if 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. Maternity In-patient Hospital admissions and birthing center admissions require notification to appropriately manage care. Your provider will provide notification to the Health Plan of your maternity admission. Please see coverage for emergent/prior authorization admissions. • In the event that the mother requests an earlier discharge, a mutual agreement must be reached between the mother and her attending Practitioner/Provider. Such discharge must be made in accordance with the medical criteria outlined in the most current version of the “Guidelines for Prenatal Care” prepared by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists including, but not limited to, the criterion that family Members or other support person(s) will be available to the mother for the first few days following early discharge. • Maternity Inpatient care in excess of 48 hours following a vaginal delivery and 96 hours following a cesarean section will be Covered if determined to be Medically Necessary by the mother’s attending Practitioner/Provider. An additional stay will be considered a separate Hospital stay and requires Prior Authorization. Refer to your Summary of Benefits and Coverage for Cost Cost-Sharing information. • High-risk Ambulance services are Covered in accordance with the Ambulance Services Benefits Section. • The services of a Licensed Midwife or Certified Nurse Midwife are Covered, for the following: o The midwife’s services must be provided strictly according to their legal scope of practice and in accordance with all applicable state licensing regulations which may include a supervisory component. o The services must be provided in preparation for or in connection with the delivery of a newborn. o For purpose of Coverage under this Agreement, the only allowable sites of delivery are a Hospital or a licensed birthing center. Elective Home Births and any prenatal or postpartum services connected with Elective Home Births are not Covered. Elective Home Birth means a birth that was planned or intended by the Member or Practitioner/Provider to occur in the home. o The combined fees of the midwife and any attending or supervising Practitioners/Providers, for all services provided before, during and after the birth, may not exceed the allowable fee(s) that would have been payable to the Practitioner/Provider had he/she been the sole Practitioner/Provider of those services.‌services.

Women’s Healthcare. This benefit has one or more exclusions as specified in the Exclusions Section. The following Woman’s Healthcare Services, in addition to services listed in the Preventive Care Section and other Sections of this Agreement are available for our female Members under the Women’s Health and Cancer Rights Act (WHCRA). Inpatient Hospital services require Prior Authorization. Obstetrical/Gynecological care includes: • Annual exams • Care related to pregnancy • Miscarriage • Therapeutic abortions • Elective abortions up to 24 weeks • Other obstetrical/gynecological services Prenatal Maternity care benefits include: • Prenatal care • Pregnancy related diagnostic tests, (including an alpha-fetoprotein IV screening test, generally between 16 and 20 and20 weeks of pregnancy, to screen for certain abnormalities in the fetus) • Visits to an Obstetrician • Certified Nurse-midwife • Licensed Midwife • Medically Necessary nutritional supplements as determined and prescribed by the attending Practitioner/Provider. Prescription nutritional supplements require Prior Authorization. • Childbirth in a Hospital or in a licensed birthing center Maternity Care In Accordance with the Newborns’ and Mothers’ Health Protection Act (the Newborns’ Act), the following benefits services are Coveredavailable: • Maternity Coverage is available to a mother and her newborn (if 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. Maternity In-patient Hospital admissions and birthing center admissions require notification to appropriately manage care. Your provider will provide notification to the Health Plan of your maternity admission. Please see coverage for emergent/prior authorization admissions. • In the event that the mother requests an earlier discharge, a mutual agreement must be reached between the mother and her attending Practitioner/Provider. Such discharge must be made in accordance with the medical criteria outlined in the most current version of the “Guidelines for Prenatal Care” prepared by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists including, but not limited to, the criterion that family Members or other support person(s) will be available to the mother for the first few days following early discharge. • Maternity Inpatient care in excess of 48 hours following a vaginal delivery and 96 hours following a cesarean section will be Covered if determined to be Medically Necessary by the mother’s attending Practitioner/Provider. An additional stay will be considered a separate Hospital stay and requires Prior Authorization. Refer to your Summary of Benefits and Coverage for Cost Sharing information. • High-risk Ambulance services are Covered in accordance with the Ambulance Services Benefits Section. • The services of a Licensed Midwife or Certified Nurse Midwife are Covered, for the following: o The midwife’s services must be provided strictly according to their legal scope of practice and in accordance with all applicable state licensing regulations which may include a supervisory component. o The services must be provided in preparation for or in connection with the delivery of a newborn. o For purpose of Coverage under this Agreement, the only allowable sites of delivery are a Hospital or a licensed birthing center. Elective Home Births and any prenatal or postpartum services connected with Elective Home Births are not Covered. Elective Home Birth means a birth that was planned or intended by the Member or Practitioner/Provider to occur in the home. o The combined fees of the midwife and any attending or supervising Practitioners/Providers, for all services provided before, during and after the birth, may not exceed the allowable fee(s) that would have been payable to the Practitioner/Provider had he/she been the sole Practitioner/Provider of those services.‌services.

Women’s Healthcare. This benefit has one or more exclusions as specified in the Exclusions Section. The following Woman’s Healthcare Services, in addition to services listed in the Preventive Care Section and other Sections of this Agreement are available for our female Members under the Women’s Health and Cancer Rights Act (WHCRA). Inpatient Hospital services require Prior Authorization. Obstetrical/Gynecological care includes: • Annual exams • Care related to pregnancy • Miscarriage • Therapeutic abortions • Elective abortions up to 24 weeks • Other obstetrical/gynecological services Prenatal Maternity care benefits include: • Prenatal care • Pregnancy related diagnostic tests, (including an alpha-fetoprotein IV screening test, generally between 16 and 20 weeks of pregnancy, to screen for certain abnormalities in the fetus) • Visits to an Obstetrician • Certified Nurse-midwife • Licensed Midwife • Medically Necessary nutritional supplements as determined and prescribed by the attending Practitioner/Provider. Prescription nutritional supplements require Prior Authorization. • Authorization Childbirth in a Hospital or in a licensed birthing center Maternity Care In Accordance with the Newborns’ and Mothers’ Health Protection Act (the Newborns’ Act), the following benefits services are Coveredavailable: • Maternity Coverage is available to a mother and her newborn (if 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. Maternity In-patient Hospital admissions and birthing center admissions require notification to appropriately manage care. Your provider will provide notification to the Health Plan of your maternity admission. Please see coverage for emergent/prior authorization Prior Authorization admissions. • In the event that the mother requests an earlier discharge, a mutual agreement must be reached between the mother and her attending Practitioner/Provider. Such discharge must be made in accordance with the medical criteria outlined in the most current version of the “Guidelines for Prenatal Care” prepared by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists including, but not limited to, the criterion that family Members or other support person(s) will be available to the mother for the first few days following early discharge. • Maternity Inpatient care in excess of 48 hours following a vaginal delivery and 96 hours following a cesarean section will be Covered if determined to be Medically Necessary by the mother’s attending Practitioner/Provider. An additional stay will be considered a separate Hospital stay and requires Prior Authorization. Refer to your Summary of Benefits and Coverage for Cost Cost-Sharing information. • High-risk Ambulance services are Covered in accordance with the Ambulance Services Benefits Section. • The services of a Licensed Midwife or Certified Nurse Midwife are Covered, for the following: o The midwife’s services must be provided strictly according to their legal scope of practice and in accordance with all applicable state licensing regulations which may include a supervisory component. o The services must be provided in preparation for or in connection with the delivery of a newborn. o For purpose of Coverage under this Agreement, the only allowable sites of delivery are a Hospital or a licensed birthing center. Elective Home Births and any prenatal or postpartum services connected with Elective Home Births are not Covered. Elective Home Birth means a birth that was planned or intended by the Member or Practitioner/Provider to occur in the home. o The combined fees of the midwife and any attending or supervising Practitioners/Providers, for all services provided before, during and after the birth, may not exceed the allowable fee(s) that would have been payable to the Practitioner/Provider had he/she been the sole Practitioner/Provider of those services.‌.

Women’s Healthcare. This benefit has one or more exclusions as specified in the Exclusions Section. The following Woman’s Healthcare Services, in addition to services listed in the Preventive Care Section and other Sections of this Agreement are available for our female Members under the Women’s Health and Cancer Rights Act (WHCRA). Inpatient Hospital services require Prior Authorization. Obstetrical/Gynecological care includes: • · Annual exams • · Care related to pregnancy • · Miscarriage • · Therapeutic abortions • · Elective abortions up to 24 weeks • · Other obstetrical/gynecological services Prenatal Maternity care benefits include: • · Prenatal care • · Pregnancy related diagnostic tests, (including an alpha-fetoprotein IV screening test, generally between 16 and 20 weeks of pregnancy, to screen for certain abnormalities in the fetus) • · Visits to an Obstetrician • · Certified Nurse-midwife • · Licensed Midwife • · Medically Necessary nutritional supplements as determined and prescribed by the attending Practitioner/Provider. Prescription nutritional supplements require Prior Authorization. • · Childbirth in a Hospital or in a licensed birthing center Maternity Care In Accordance with the Newborns’ and Mothers’ Health Protection Act (the Newborns’ Act), the following benefits services are Coveredavailable: • · Maternity Coverage is available to a mother and her newborn (if 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. Maternity In-patient Hospital admissions and birthing center admissions require notification to appropriately manage care. Your provider will provide notification to the Health Plan of your maternity admission. Please see coverage for emergent/prior authorization admissions. • · In the event that the mother requests an earlier discharge, a mutual agreement must be reached between the mother and her attending Practitioner/Provider. Such discharge must be made in accordance with the medical criteria outlined in the most current version of the “Guidelines for Prenatal Care” prepared by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists including, but not limited to, the criterion that family Members or other support person(s) will be available to the mother for the first few days following early discharge. • · Maternity Inpatient care in excess of 48 hours following a vaginal delivery and 96 hours following a cesarean section will be Covered if determined to be Medically Necessary by the mother’s attending Practitioner/Provider. An additional stay will be considered a separate Hospital stay and requires Prior Authorization. Refer to your Summary of Benefits and Coverage for Cost Sharing information. • · High-risk Ambulance services are Covered in accordance with the Ambulance Services Benefits Section. • · The services of a Licensed Midwife or Certified Nurse Midwife are Covered, for the following: o The midwife’s services must be provided strictly according to their legal scope of practice and in accordance with all applicable state licensing regulations which may include a supervisory component. o The services must be provided in preparation for or in connection with the delivery of a newborn. o For purpose of Coverage under this Agreement, the only allowable sites of delivery are a Hospital or a licensed birthing center. Elective Home Births and any prenatal or postpartum services connected with Elective Home Births are not Covered. Elective Home Birth means a birth that was planned or intended by the Member or Practitioner/Provider to occur in the home. o The combined fees of the midwife and any attending or supervising Practitioners/Providers, for all services provided before, during and after the birth, may not exceed the allowable fee(s) that would have been payable to the Practitioner/Provider had he/she been the sole Practitioner/Provider of those services.‌services.

Women’s Healthcare. This benefit has one or more exclusions as specified in the Exclusions Section. The following Woman’s Healthcare Services, in addition to services listed in the Preventive Care Section and other Sections of this Agreement are available for our female Members under the Women’s Health and Cancer Rights Act (WHCRA). Inpatient Hospital services require Prior Authorization. Obstetrical/Gynecological care includes: • Annual exams • Care related to pregnancy • Miscarriage • Therapeutic abortions • Elective abortions up to 24 weeks • Other obstetrical/gynecological services Prenatal Maternity care benefits include: • Prenatal care • Pregnancy related diagnostic tests, (including an alpha-fetoprotein IV screening test, generally between 16 and 20 weeks of pregnancy, to screen for certain abnormalities in the fetus) • Visits to an Obstetrician • Certified Nurse-midwife • Licensed Midwife • Medically Necessary nutritional supplements as determined and prescribed by the attending Practitioner/Provider. Prescription nutritional supplements require Prior Authorization. • Childbirth in a Hospital or in a licensed birthing center Maternity Care In Accordance with the Newborns’ and Mothers’ Health Protection Act (the Newborns’ Act), the following benefits services are Coveredavailable: • Maternity Coverage is available to a mother and her newborn (if 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. Maternity In-patient Hospital admissions and birthing center admissions require notification to appropriately manage care. Your provider will provide notification to the Health Plan of your maternity admission. Please see coverage for emergent/prior authorization Prior Authorization admissions. • In the event that the mother requests an earlier discharge, a mutual agreement must be reached between the mother and her attending Practitioner/Provider. Such discharge must be made in accordance with the medical criteria outlined in the most current version of the “Guidelines for Prenatal Care” prepared by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists including, but not limited to, the criterion that family Members or other support person(s) will be available to the mother for the first few days following early discharge. • Maternity Inpatient care in excess of 48 hours following a vaginal delivery and 96 hours following a cesarean section will be Covered if determined to be Medically Necessary by the mother’s attending Practitioner/Provider. An additional stay will be considered a separate Hospital stay and requires Prior Authorization. Refer to your Summary of Benefits and Coverage for Cost Cost-Sharing information. • High-risk Ambulance services are Covered in accordance with the Ambulance Services Benefits Section. • The services of a Licensed Midwife or Certified Nurse Midwife are Covered, for the following: o The midwife’s services must be provided strictly according to their legal scope of practice and in accordance with all applicable state licensing regulations which may include a supervisory component. o The services must be provided in preparation for or in connection with the delivery of a newborn. o For purpose of Coverage under this Agreement, the only allowable sites of delivery are a Hospital or a licensed birthing center. Elective Home Births and any prenatal or postpartum services connected with Elective Home Births are not Covered. Elective Home Birth means a birth that was planned or intended by the Member or Practitioner/Provider to occur in the home. o The combined fees of the midwife and any attending or supervising Practitioners/Providers, for all services provided before, during and after the birth, may not exceed the allowable fee(s) that would have been payable to the Practitioner/Provider had he/she been the sole Practitioner/Provider of those services.‌

Women’s Healthcare. This benefit has one or more exclusions as specified in the Exclusions Section. The following Woman’s Healthcare Services, in addition to services listed in the Preventive Care Section and other Sections of this Agreement are available for our female Members under the Women’s Health and Cancer Rights Act (WHCRA). Inpatient Hospital services require Prior Authorization. Obstetrical/Gynecological care includes: • Annual exams • Care related to pregnancy • Miscarriage • Therapeutic abortions • Elective abortions up to 24 weeks • Other obstetrical/gynecological services Prenatal Maternity care benefits include: • Prenatal care • Pregnancy related diagnostic tests, (including an alpha-fetoprotein IV screening test, generally between 16 and 20 weeks of pregnancy, to screen for certain abnormalities in the fetus) • Visits to an Obstetrician • Certified Nurse-midwife • Licensed Midwife • Medically Necessary nutritional supplements as determined and prescribed by the attending Practitioner/Provider. Prescription nutritional supplements require Prior Authorization. • Childbirth in a Hospital or in a licensed birthing center Maternity Care In Accordance with the Newborns’ and Mothers’ Health Protection Act (the Newborns’ Act), the following benefits services are Coveredavailable: • Maternity Coverage is available to a mother and her newborn (if 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. Maternity In-patient Hospital admissions and birthing center admissions require notification to appropriately manage care. Your provider will provide notification to the Health Plan of your maternity admission. Please see coverage for emergent/prior authorization admissions. • In the event that the mother requests an earlier discharge, a mutual agreement must be reached between the mother and her attending Practitioner/Provider. Such discharge must be made in accordance with the medical criteria outlined in the most current version of the “Guidelines for Prenatal Care” prepared by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists including, but not limited to, the criterion that family Members or other support person(s) will be available to the mother for the first few days following early discharge. • Maternity Inpatient care in excess of 48 hours following a vaginal delivery and 96 hours following a cesarean section will be Covered if determined to be Medically Necessary by the mother’s attending Practitioner/Provider. An additional stay will be considered a separate Hospital stay and requires Prior Authorization. Refer to your Summary of Benefits and Coverage for Cost Sharing information. • High-risk Ambulance services are Covered in accordance with the Ambulance Services Benefits Section. • The services of a Licensed Midwife or Certified Nurse Midwife are Covered, for the following: o The midwife’s services must be provided strictly according to their legal scope of practice and in accordance with all applicable state licensing regulations which may include a supervisory component. o The services must be provided in preparation for or in connection with the delivery of a newborn. o For purpose of Coverage under this Agreement, the only allowable sites of delivery are a Hospital or a licensed birthing center. Elective Home Births and any prenatal or postpartum services connected with Elective Home Births are not Covered. Elective Home Birth means a birth that was planned or intended by the Member or Practitioner/Provider to occur in the home. o The combined fees of the midwife and any attending or supervising Practitioners/Providers, for all services provided before, during and after the birth, may not exceed the allowable fee(s) that would have been payable to the Practitioner/Provider had he/she been the sole Practitioner/Provider of those services.‌services. • Ultrasounds related to maternity care. Ultrasounds do not require prior authorization.

Women’s Healthcare. This benefit has one or more exclusions as specified in the Exclusions Section. The following Woman’s Healthcare Services, in addition to services listed in the Preventive Care Section and other Sections of this Agreement are available for our female Members under the Women’s Health and Cancer Rights Act (WHCRA). Inpatient Hospital services require requires Prior Authorization. Obstetrical/Gynecological care includes: • Annual exams • Care related to pregnancy • Miscarriage • Therapeutic abortions • Elective abortions up to 24 weeks • Other obstetrical/gynecological services Prenatal Maternity care benefits include: • Prenatal care • Pregnancy related diagnostic tests, (including an alpha-fetoprotein IV screening test, generally between 16 and 20 weeks of pregnancy, to screen for certain abnormalities in the fetus) • Visits to an Obstetrician • Certified Nurse-midwife • Licensed Midwife • Medically Necessary nutritional supplements as determined and prescribed by the attending Practitioner/Provider. Prescription nutritional supplements require Prior Authorization. Authorization • Childbirth in a Hospital or in a licensed birthing center Maternity Care In Accordance with the Newborns’ and Mothers’ Health Protection Act (the Newborns’ Act), the following benefits services are Coveredavailable: • Maternity Coverage is available to a mother and her newborn (if 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. Maternity In-patient Hospital admissions and birthing center admissions require notification to appropriately manage care. Your provider will provide notification to the Health Plan of your maternity admission. Please see coverage for emergent/prior authorization admissions. • In the event that the mother requests an earlier discharge, a mutual agreement must be reached between the mother and her attending Practitioner/Provider. Such discharge must be made in accordance with the medical criteria outlined in the most current version of the “Guidelines for Prenatal Care” prepared by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists including, but not limited to, the criterion that family Members or other support person(s) will be available to the mother for the first few days following early discharge. • Maternity Inpatient care in excess of 48 hours following a vaginal delivery and 96 hours following a cesarean section will be Covered if determined to be Medically Necessary by the mother’s attending Practitioner/Provider. An additional stay will be considered a separate Hospital stay and requires Prior Authorization. Refer to your Maternity and delivery section of your Summary of Benefits and Coverage for Cost Sharing information. • High-risk Ambulance services are Covered in accordance with the Ambulance Services Benefits Section. • The services of a Licensed Midwife or Certified Nurse Midwife are Covered, for the following: o The midwife’s services must be provided strictly according to their legal scope of practice and in accordance with all applicable state licensing regulations which may include a supervisory component. o The services must be provided in preparation for or in connection with the delivery of a newborn. o For purpose of Coverage under this Agreement, the only allowable sites of delivery are a Hospital or a licensed birthing center. Elective Home Births and any prenatal or postpartum services connected with Elective Home Births are not Covered. Elective Home Birth means a birth that was planned or intended by the Member or Practitioner/Provider to occur in the home. o The combined fees of the midwife and any attending or supervising Practitioners/Providers, for all services provided before, during and after the birth, may not exceed the allowable fee(s) that would have been payable to the Practitioner/Provider had he/she been the sole Practitioner/Provider of those services.‌services.