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You are here: Summary Of Benefits And Coverage Base Coverage

Maternity and Newborn Care

CONTENT: Maternity and Newborn Care

Service

In-Network Coinsurance

Out-of-Network Coinsurance

Additional Information

Office Visits for Pregnancy

20%

40%

Cost sharing does not apply for preventive services. Preventive services are subject to frequency limitations. Not covered for dependent children.

Childbirth/Delivery Professional Services

20%

40%

Delivery expenses are not covered for dependent children. Covered at no charge for employees and spouses in Maternity Management Program.

Childbirth/Delivery Facility Services

20%

40%

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