As an exception to the Medically Necessary and Appropriate requirement of this Contract, We also provide coverage for the mother and newly born child for: a minimum of 48 hours of Inpatient care in a [Network] Hospital following a vaginal delivery; and a minimum of 96 hours of Inpatient care in a [Network] Hospital following a cesarean section. We provide childbirth and newborn coverage subject to the following: the attending Practitioner must determine that Inpatient care is medically necessary; or the mother must request the Inpatient care. [As an alternative to the minimum level of Inpatient care described above, the mother may elect to participate in a home care program provided by Us.] Private accommodations [will be provided only when approved in advance by Us]. If a [Member] occupies a private room without such approval [Member] shall be directly liable to the Hospice, Hospital, Rehabilitation Center or Skilled Nursing Facility for the difference between payment by Us to the Hospice, Hospital, Rehabilitation Center or Skilled Nursing Facility of the per diem or other agreed upon rate for semi-private accommodation established between Us and the [Network] Hospice, [Network] Hospital, [Network] Rehabilitation Center or [Network] Skilled Nursing Center and the private room rate. General nursing care Use of intensive or special care facilities X-ray examinations including CAT scans but not dental x-rays Use of operating room and related facilities Magnetic resonance imaging "MRI" Drugs, medications, biologicals Cardiography/Encephalography Laboratory testing and services Pre- and post-operative care Special tests Nuclear medicine Therapy Services Oxygen and oxygen therapy Anesthesia and anesthesia services Blood, blood products and blood processing Intravenous injections and solutions 19. Surgical, medical and obstetrical services. We also cover reconstructive breast Surgery, Surgery to restore and achieve symmetry between the two breasts and the cost of prostheses following a mastectomy on one breast or both breasts. We also cover treatment of the physical complications of mastectomy, including lymphedemas. We also cover surgical treatment of morbid obesity for one surgical procedure within a two-year period, measured from the date of the first surgical procedure to treat morbid obesity, unless a multi-stage procedure is planned and We authorize coverage for such
As an exception to the Medically Necessary and Appropriate requirement of this Contract, We also provide coverage for the mother and newly born child for: a minimum of 48 hours of Inpatient care in a [Network] Hospital following a vaginal delivery; and a minimum of 96 hours of Inpatient care in a [Network] Hospital following a cesarean section. We provide childbirth and newborn coverage subject to the following: the attending Practitioner must determine that Inpatient care is medically necessary; or the mother must request the Inpatient care. [As an alternative to the minimum level of Inpatient care described above, the mother may elect to participate in a home care program provided by Us.] Private accommodations [will be provided only when approved in advance by Us]. If a [Member] occupies a private room without such approval [Member] shall be directly liable to the Hospice, Hospital, Rehabilitation Center or Skilled Nursing Facility for the difference between payment by Us to the Hospice, Hospital, Rehabilitation Center or Skilled Nursing Facility of the per diem or other agreed upon rate for semi-private accommodation established between Us and the [Network] Hospice, [Network] Hospital, [Network] Rehabilitation Center or [Network] Skilled Nursing Center and the private room rate. General nursing care Use of intensive or special care facilities X-ray examinations including CAT scans but not dental x-rays Use of operating room and related facilities Magnetic resonance imaging "MRI" Drugs, medications, biologicals Cardiography/Encephalography Laboratory testing and services Pre- and post-operative care Special tests Nuclear medicine Therapy Services Oxygen and oxygen therapy Anesthesia and anesthesia services Blood, blood products and blood processing Intravenous injections and solutions 19. Surgical, medical and obstetrical services. We also cover reconstructive breast Surgery, Surgery to restore and achieve symmetry between the two breasts and the cost of prostheses following a mastectomy on one breast or both breasts. We also cover treatment of the physical complications of mastectomy, including lymphedemas. We also cover surgical treatment of morbid obesity for one surgical procedure within a two-year period, measured from the date of the first surgical procedure to treat morbid obesity, unless a multi-stage procedure is planned and We authorize coverage for such
HMO%20POS%20Contract%202018%20A.docx