Maternity Benefits
Maternity benefits are provided to covered participants or covered spouses. Other female dependents are eligible for limited maternity benefits as indicated in this section. For more information, see the Medical Management and Utilization Review section.
Benefits for the following prenatal laboratory and diagnostic procedures will be provided at 100 percent of the allowable charge, not subject to the calendar year deductible, when services are provided by a network provider:
Test | Limit per Pregnancy |
|---|---|
Hemoglobin/Hematocrit/CBC | 2 |
Antibody Test for Rh-Negative (if unsensitized) | 1 |
Gestational Diabetes Screening at 24 weeks or after | 1 |
Cervical Cytology (PAP) | 1 |
HIV Screening | 1 |
Gonorrhea Screening | 1 |
Syphilis Screening | 1 |
Chlamydia Screening | 1 |
Bacteriuria Screening | 1 |
Hepatitis B Screening | 1 |
Note: For covered participants or covered spouses, other prenatal laboratory and diagnostic procedures, inpatient hospital delivery and other covered services are subject to the deductible and coinsurance. For covered female dependents, no benefits will be provided for any other prenatal laboratory and diagnostic procedures, delivery, and other services beyond those listed above.
Maternity Management Program
Employees and covered spouses are encouraged to participate in the Maternity Management Program provided by ActiveHealth as early in the pregnancy as possible. This program is voluntary and offered at no charge. It provides an ActiveHealth maternity nurse to assist participants throughout the pregnancy, help with early identification of any risk factors, and provide educational materials and support during and after delivery.
As part of the program, participants will have access to an online library created specifically for expectant mothers. Participants or covered spouses must complete three program activities, which can include calls with an ActiveHealth maternity nurse and digital coaching. At least one call with an ActiveHealth maternity nurse is required.
Subject to successful completion of the Maternity Management Program, routine physician's delivery charges and the following prenatal services will be provided at 100 percent when rendered by a network provider:
Service | Limit per Pregnancy |
|---|---|
Ultrasound | 4 |
Alpha-fetoprotein | 1 |
Group B Strep | 1 |
Urinalysis, screening dipstick | 3 |
Urinalysis, spun | 1 |
Note: Other prenatal laboratory and diagnostic procedures, inpatient hospital delivery charges, anesthesia, and other covered services are subject to the deductible and coinsurance.
Special Note: Adding a Newborn
In order for a newborn to be covered from the date of birth, an Application for Coverage form must be submitted to your Human Resources office within 60 days of the date of birth with the appropriate premiums. Simply reporting the baby's birth by phone to ActiveHealth, Acentra, or BCBSMS does not add the baby to the participant's coverage.