 |
 |
      |
 |
  |
|
|
|
|
 |
|
Home > Health Plan > Maternity Benefits
MATERNITY BENEFITS Some plans do not include every benefit mentioned. Refer to your plan booklet to verify which benefits are included in your plan.
The Plan covers pregnancy in the same manner and benefit rate as most other covered medical conditions. The benefit rate
is 85% for hospital charges at a BlueCross BlueShield PPO hospital, and 80% of the BlueCross scheduled allowance for
physician and related charges.
An additional deductible and a lower benefit rate apply if a non-PPO hospital is used on a non-emergency basis. See the
Summary of Benefits for your Plan (D5 or B5)
for specifics.
BlueCross BlueShield Participating Provider Option (PPO)
When you use a PPO hospital, the charges are substantially discounted and paid at the higher 85% benefit rate. Many quality
hospitals and physicians are a part of the network, including world-renowned healthcare providers.
When you use a PPO physician, you receive treatment at an agreed upon, discounted rate. The Fund shares these savings
with you by reducing your out-of-pocket costs. The Fund also pays a higher percentage of your expenses when PPO
hospitals are used.
To request a listing of BlueCross BlueShield PPO hospitals in Illinois, click on PPO Hospital
Listing. Or, go on-line and locate a PPO hospital or physician anywhere. Go to bcbs.com,
click on "Find a Doctor or Hospital" and follow the instructions from there. Or call BlueCross Blueshield at 800-810-BLUE (2583).
Pre-Natal Testing
Doctors often order various tests during a pregnancy for diagnostic purposes. The Plan covers the initial laboratory tests and
a screening ultrasound once per trimester of the pregnancy. Other tests are covered if they are ordered to diagnose or rule
out a condition based on symptoms observed by the physician.
Home Births
The Plan covers the birth of your child at home if that is your choice. Benefits are payable if the services are provided by a
properly licensed agency and pre-certified by Health Information Services at the Benefits
Fund Office. Home health agencies often advise that home births are less expensive than hospital births. This is not necessarily
true. Please note that the benefits payable under the Plan for a home birth will not exceed the normal charges experienced
for an inpatient birth at a PPO hospital.
Pre-Certification Required
To receive your full benefits, the Benefits Fund Office must be notified of your pregnancy and your expected date of delivery.
The nurses in Health Information Services will be available to answer any questions you
may have regarding coverage.
Income Protection
Pregnancy is a qualifying condition for Income Protection Benefits for full-time employee-members who are covered under
Plan D5 (Plan B5 does not include this benefit). For greater details, go to the Income
Protection Benefit description or to the People Often Ask About Disability Income Protection
pages on this website.
Continuation of Medical Coverage
If your doctor finds medical reasons based on objective proof that make it essential for you to stop working (total disability)
before you deliver, then you may be eligible under the federal Family and Medical Leave Act for up to a 12-week
leave-of-absence. During the leave-of-absence, your employer will continue to make contributions for you into the Health
Fund to maintain your health coverage.
If you remain disabled after the 12-week period or if you do not qualify for a leave-of-absence under the Family and Medical
Leave Act, you may receive an extension of your medical coverage of up to six months. To be considered for an extension,
you must immediately file a claim form, completed by you and your store manager;
also, your doctor's statement of disability must be included.
If you remain disabled at the end of the extension and/or the extension ends before your delivery date, you will have to make
self-payments to continue your coverage. Contact the Billing Department at the Benefits
Fund Office to find out about self-payments under COBRA to extend your coverage.
If you stop working or do not return to work while you are not totally disabled, all your coverage will terminate regardless of
any employer-approved leave of absence. Under the Federal law, COBRA, you may make
self-payments to the Plan to continue your coverage. Contact the Billing Department at the
Benefits Fund Office for details.
Coverage for Your Newborn Child
If you were covered under Plan D5 (Plan B5 does not include dependent coverage) and were eligible for dependent coverage
at the time you stopped working and if you are covered at the time you deliver, then your new baby is automatically covered
for medical or surgical procedures resulting from an illness, injury or congenital defect. The Plan does not cover circumcision
or the treatment of jaundice of newborns unless this condition becomes severe.
Once out of the hospital, benefits for immunizations and doctor visits for routine care of dependent children up to their
second birthday are payable at 100% with no deductible required up to a lifetime maximum of $500.
If the mother is your dependent child, only expenses for the mother are covered. Baby-related expenses are not covered
because grandchildren are not eligible for coverage under the Plan.
|
||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||
