See the list of covered provider types for providers whose services are covered by the plan.
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 associated with pregnancy, including pregnancies resulting from infertility treatment.
Early elective deliveries may not be covered; see "When Deliveries Before 39 Weeks Gestation May Not Be Covered" below.
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 or coinsurance when you see a preferred provider.
For non-routine hospitalization of the newborn, you will also pay coinsurance for facility and professional services for the newborn.
Circumcision is covered as a medical benefit
for males only (subject to the deductible and coinsurance). As this is not a preventive service, you will pay the newborn's deductible and coinsurance for this service.
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.
When Deliveries Before 39 Weeks Gestation May Not Be Covered
Vaginal or Cesarean deliveries before 39 weeks of gestation are covered when the services are medically necessary; examples include:
- Due to a medical emergency affecting the mother or baby.
- Indicated due to a medical condition of the mother or baby for which a delivery is medically necessary.
- Labor begins spontaneously (without medical intervention) before the mother reaches 39 weeks of gestation.
Vaginal or Cesarean deliveries before 39 weeks of gestation are not covered
when the services are:
- Scheduled for convenience and not for medical necessity or medical emergency.
- Neither the mother or baby have a medical condition for which immediate delivery is medically necessary.
- Not due to a medical emergency affecting the mother or baby.
Talk to your doctor about whether early delivery is medically necessary. For questions about this policy, call UMP 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.
- Counseling and HIV screening.
- Purchase of manual and electric breast pumps for pregnant and nursing women, plus supplies included with the initial purchase. Hospital-grade pumps are not covered.
- Use of low-dose aspirin (81mg/day) after 12 weeks' gestation in women at high risk of preeclampsia. You must have a prescription from your provider and purchase from a network pharmacy to get the medication at no cost; see "Products Covered Under the Preventive Care Benefit."
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
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.