MEDICA_®

Description
Maternity or prenatal includes the comprehensive package of medical and psycho-social services provided throughout the pregnancy. This includes risk assessment, serial surveillance, prenatal education, and use of specialized skills and technology.


What are the services included in my maternity benefits?

• Prenatal and maternity benefits include services when the primary reason for the care is pregnancy. This includes but is not limited to:
  • Ultrasounds
  • Amniocentesis
  • Services and supplies related to gestational diabetes
  • Care related to miscarriage and ectopic pregnancies

Where do I find out how this will be covered with my benefit plan?

• You will find your prenatal benefits in the Professional/Physician Services section of your benefit document. They will be paid under the prenatal care services received from a physician during an office visit or outpatient hospital visit section.
• You will find your labor and delivery benefits for the physician in the Professional/Physician Services section of your benefit document. This will be paid for under the services received from a physician during an inpatient stay for prenatal care and labor and delivery section.
• You will find your labor and delivery benefits for the hospital under the Hospital Services section of your benefit document. This will be paid for under the inpatient services, including inpatient maternity labor and deliver services section.

Things to remember

• Make sure to verify that your physician is part of the Medica network. Go to Find A Doctor to verify this.
• Be sure that your physician has privileges at a hospital you prefer and that the hospital is also part of the Medica network. Your hospital stay does not need to be pre-certified.
• Your physician knows best as to how long you should remain in the hospital following your delivery. Medica will cover the length of stay that your doctor deems medically necessary.
• Enroll your baby on your health plan as soon after birth as possible. This will ensure that the bills are paid and will be less hassle for you after the baby has arrived.
• Medica will cover one home health visit for you and the baby within four days of discharge. If you choose to take advantage of this, be sure that the home health agency is in the Medica network.
• Breast pumps are not covered on most policies unless deemed medically necessary by your doctor. View criteria for medical necessity.
• If you have any further questions regarding your benefits, please contact Customer Service at the number on the back of your ID card.

Return to Coverage Guidelines.