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HSA Plan

Network

20% coinsurance after deductible

Non-Network

40% coinsurance after deductible

PPO 750 Plan

Network

20% coinsurance after deductible

Non-Network

40% coinsurance after deductible

PPO 1250 Plan

Network

20% coinsurance after deductible

Non-Network

40% coinsurance after deductible

Routine prenatal and postnatal office visits and screenings recommended by the Health Resources and Services Administration are covered at 100 percent. Other care is subject to the deductible and coinsurance.

Newborns and their mothers are allowed hospital stays of at least 48 hours after normal birth and 96 hours after cesarean section birth. If discharge occurs earlier, the plan provides post-discharge care consisting of a two-visit minimum, at least one in the home.

During a hospital admission for delivery, only the mother's claims will be subject to a deductible and coinsurance when the mother is covered under the plan. Newborns covered by a PPO plan will be subject to deductible and coinsurance if mother is not covered under the plan. Newborns covered by the Health Savings Account Plan will be subject to deductible and coinsurance regardless of whether the mother is covered under the plan. The newborn will be subject to his/her own deductible and coinsurance after release from the hospital or transfer to another facility.

Preauthorization by medical plan required for maternity stays longer than 48 hours (normal delivery) or 96 hours (C-section).


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