The Health Plan offers extensive reproductive health coverage benefits, including, but not limited to:
- Birthing centers
- Pre-natal care
A birthing center is a facility established to manage low risk, normal, uncomplicated pregnancies with delivery within 24 hours of admission to the center. For Health Plan coverage to be provided, the birthing center must be licensed by the state (if required by the state) as a birthing center.
As an alternative to traditional hospital delivery of a child, the Health Plan pays benefits for the following services provided by a birthing center:
- Pre-natal care;
- Use of the birthing room;
- Services rendered during delivery, including the first 48 hours of follow-up care;
- Care for the newborn and post-partum care of the mother;
- Routine nursery care; and
- Services of a midwife under the supervision of a medical doctor.
Pre-natal care is covered at birthing centers (as described above), but also at traditional medical provider sources such as internists, Family Practice and General Practice providers, OB/GYNs, and other medical professionals. The Health Plan’s pre-natal care includes coverage for such things as supplements like folic acid.
The Health Plan does cover testing to determine if there is a fertility issue when a couple is unable to conceive. However, the health Plan does not cover fertility treatment.
Various forms of contraception are covered by the Health Fund. Some forms are covered under medical benefits and some under prescription drug benefits or preventive services.
Some of the forms of contraception/birth control that are covered by the Health Plan:
- Barrier methods, like diaphragms and sponges
- Hormonal methods, like birth control pills and vaginal rings
- Implanted devices, like intrauterine devices (IUDs)
- Sterilization procedures, such as tubal ligation and vasectomies
- Patient education and counseling
*NOTE: The Fund will cover approved women’s contraceptive methods under the Preventive Care Benefits at 100% with no deductible or copayment if rendered by a network health care provider in accordance with the applicable requirements
As you can see, Health Fund coverage for reproductive services is rich and variegated. You can find out even more by reviewing the Summary Plan Description (SPD) which is available online.