See the list of covered provider types for providers whose services are covered by the plan.
Effective January 1, 2015: Circumcision will be covered under the medical benefit.
Services for pregnancy and its complications are covered. Professional services covered include:
- Prenatal and postnatal care.
- Amniocentesis and related genetic counseling and testing during pregnancy
- Prenatal testing (follows state regulations in Washington Administrative Code 246-680-020)
- Vaginal or cesarean delivery
- Care of complications resulting from pregnancy
For inpatient hospital charges related to a routine childbirth, you pay:
- Any remaining deductible for the mother.
- Coinsurance for facility charges and professional services for the mother while hospitalized.
- The deductible for the newborn; however, if only preventive care services are billed for the newborn, you will not pay the baby's deductible.
For non-routine hospitalization of the newborn, you will also pay coinsurance for facility and professional services for the newborn.
A newborn dependent of an enrollee is covered from birth to at least 21 days following birth. See ”Adding a New Dependent to Your Coverage" for what you need to do for continued coverage.
If your obstetric care began while covered under another health plan, and the providers are not part of the plan network, call Customer Service at 1-888-849-3681.
Services Covered as Preventive
The following services are covered as preventive (not subject to the deductible or coinsurance when you see a preferred provider):
- Screening for gestational diabetes during pregnancy.
- Purchase or rental of manual and electric breast pumps during breastfeeding, plus supplies at the time of initial purchase. Hospital-grade pumps are not covered.
See "Coverage of preventive care" for more prenatal, newborn, and well-baby services that are covered as preventive. See "Guidelines for Drugs Covered" for coverage of prenatal vitamins.
ALERT! Newborn hearing screenings are not subject to the deductible and are covered at 100% of the allowed amount.
Limitations on Ultrasounds During Pregnancy
Note: The following limits do not apply to high-risk pregnancies. For example, a multiple pregnancy is considered high risk.
Ultrasounds during pregnancy are covered as follows:
- One in week 13 or earlier.
- One during weeks 16-22.
Additional ultrasound(s) may be covered when medically necessary for the diagnosis, management, and treatment of complications of pregnancy on appeal