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Individual & Family Plan: Maternity Rider 


 Ancillary Services

 You pay
This provision applies to this entire subsection, unless specifically stated otherwise under any benefit provision. Ancillary services may include, but are not limited to: labs, x-rays or other diagnostic tests provided during a physician or urgent care visit.

20% co-insurance after a $1,000 deductible

 Maternity Services

  
This provision applies to this entire subsection, unless specifically stated otherwise under any benefit provision. Ancillary services may include, but are not limited to: labs, x-rays or other diagnostic tests provided during a physician or urgent care visit. 20% co-insurance after a $1,000 deductible is met.

Covered Services:

          Physician and Hospital Services

Prenatal and postpartum care, including services directly related to deliveries, ectopic pregnancies, Cesarean sections, medically necessary abortions and miscarriages.

20% co-insurance after a $1,000 deductible is met.

 Non-Covered Services:

  1. Amniocentesis or CVS (Chorionic Villi Sampling), performed exclusively for sex determination.
  2. Birthing classes (e.g. Lamaze).
  3. Elective abortions.
  4. Home or intended out of hospital deliveries (e.g. free standing birthing centers).
  5. Maternity services received outside the service area during the last 30 days of the pregnancy.
  6. Treatment, services or supplies for a third party or non-member traditional surrogate or gestational carrier.
  7. All charges or costs exceeding a benefit maximum.
 100%

HERE ARE SOME IMPORTANT THINGS TO REMEMBER ABOUT THESE BENEFITS:

  • You have a waiting period of 270 days from your effective date of coverage before benefits are available.
  • This Maternity Rider is available only at the time of enrollment in our Individual Policy or in the event of marriage. You have 31 days from the date of marriage to submit an application for maternity coverage. If you cancel this Maternity Rider, or if DHP cancels this Maternity Rider for non-payment of premium, you can not purchase this Maternity Rider again.
  • Second opinions are covered as long as there are benefits available and the covered services are provided by a plan provider and a written referral request is obtained if needed.
  • No coverage is available for charges for missed appointments, or charges for telephone consultation by or between providers.
  • You may see any plan OB/GYN specialist for covered obstetrics and gynecology services without obtaining a referral from your PCP.
 
 

Statement of Rights under the Newborns' and Mothers' Health Protection Action

Under federal law, health insurers such as Dean generally may not restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. Federal law does not prohibit the mother's or newborn's attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). If this occurs, Dean will only provide benefits for the shorter stay. Dean may not require you to obtain prior authorization for stays that are not in excess of 48 hours (or 96 hours). Although not required, you may obtain a pre-certification for services that would allow you to reduce your out-of-pocket costs. For information on pre-certification, please call Dean's Customer Care Center.