Are you having a baby? Know your benefits.
Posted on May 27, 2016
If you are expecting a baby, you probably have questions about your health plan’s prenatal and maternity benefits. Health New England offers many benefits to help you during your pregnancy, at childbirth and beyond.
Prenatal care
Prenatal care is very important to the health of the expectant mother and child, that’s why the following prenatal services are covered as preventive care with no deductible or copay required when using in-network providers:
• Routine OB/GYN prenatal visits
• Routine prenatal lab services
• Routine prenatal ultrasound
• Routine newborn nursery charges
• Newborn hearing screening
Harmony prenatal test
In certain circumstances, your provider may recommend a Harmony prenatal test, which is a new type of test that analyzes DNA in a blood sample to predict the risk of Down syndrome and other genetic conditions. This test requires your doctor to obtain prior authorization from Health New England. Your cost sharing (copay/deductible) will apply according to your plan benefits.
Hospital admission
When it’s time for you to deliver, as part of your inpatient hospital admission, Health New England will cover childbirth in the hospital setting* regardless of the method of childbirth:
• Vaginal or standard childbirth
• Water birth (in birthing tub at the hospital)
• Cesarean or C-section delivery
• Use of yoga, exercise balls, squat bar, etc.
*Home deliveries are not covered.
Your cost sharing (copay/deductible) will apply according to your plan benefits.
Massachusetts law gives mothers the right to stay in the hospital with the newborn for at least 48 hours after giving birth, or 96 hours after birth by C-section.
Free breast pump
Another benefit included in your plan is a free breast pump.** Health New England will cover one manual or electric breast pump at no cost to you. Prior authorization is not required.
To get one in advance, all you need is a prescription from your doctor, and you must obtain the breast pump from an in-plan durable medical equipment (DME) provider. For a list of DME providers, go to healthnewengland.org/provider-search, or contact Member Services for assistance.
Some hospital maternity programs offer breast pumps, which are also covered by Health New England. Be sure to ask ahead of time what is available at your local hospital.
**Deductible/copay applies for some self-funded plan members.
Breastfeeding and lactation consultation
Breastfeeding is a personal choice, and an important one for your baby. If you choose, you can receive lactation consultation during your hospital stay or after being discharged as part of your Health New England plan.
Lactation consultants are professional breastfeeding specialists trained to teach mothers how to feed their babies. They can also help women experiencing breastfeeding problems, such as latching difficulties, painful nursing and low milk production.
To find a lactation consultant near you, visit the International Lactation Consultant Association website at ilca.org or call Member Services for assistance finding an in-network lactation consultant.
Post-partum home visit
Once you arrive home with your new bundle of joy, you are covered for one post-partum home visit within 48 hours of discharge, regardless of the length of your hospital stay. This visit is initiated by the hospital and conducted by a registered nurse who will evaluate you and your newborn to be sure you are both healthy. The nurse will talk with you about your post-partum experience, self-care, infant care and feeding, and answer any questions you may have. Health New England may cover more than one home visit, if it is medically necessary.
Add your newborn to your plan within 30 days
As you settle into your new life with your baby, keep in mind that you must notify Health New England or your employer group of your new addition within 30 days of birth. This will ensure that your newborn is enrolled as a member of your health plan and is covered.
If you have any questions about the above benefits or about your plan, call Member Services at (413) 787-4004 or toll-free at (800) 310-2835, Monday – Friday, 8:00 a.m. – 6:00 p.m. We are happy to help.
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