Expecting a Baby
Congratulations! The birth of a child qualifies as a life-changing event and allows you to make changes to your benefits elections, provided you do so within
31 days of the child arriving.
Healthy Pregnancy
Once you know you are pregnant, don't forget to call UnitedHealthcare and enroll in their Healthy Pregnancy Program right away.
If you have questions or concerns about your pregnancy, NurseLine Services is available 24-hours a day, 7 days a week. A registered nurse can answer many of
your health related questions. Call 866-549-8604 any time.
Pre-Natal Vitamins
Pre-natal vitamins are important for a healthy pregnancy. Once you have a written prescription from your doctor, you can order a 90-day supply from E-xpress
Scripts for just one copay. Simply complete the Express Scripts prescription order form (PDF) and mail it to Express Scripts along with your
physician's original prescription. (To save time, print out the fax version of the order form (PDF), and have your physician fax it to Express
Scripts along with the original prescription.) You will receive your pre-natal vitamins in the mail within two weeks. For refills, call Express Scripts at
1-866-291-2607 or visit www.express-scripts.com and click on "Refill".
Prepare For Your Baby
The LifeManagement Program provides confidential counseling and 24-hour telephone consultation with experienced professionals at no cost to you through Magellan
Health Services. Gain insight on how to manage this new life challenge or discuss concerns you may have about parenting, budgeting and career options. Call
LifeManagement at 1-800-980-2273.
Maternity Care
Your Enterprise health insurance plan through UnitedHealthcare covers and pays expenses for pregnancy on the same basis as an illness. The specifics of your coverage will vary slightly depending on whether you enrolled in the PPO300, PPO600 or EPO plan. The initial office visit to confirm your pregnancy is paid at 100% after the office visit copay under all three plans.
For in-network PPO300 coverage, delivery and hospital stay is paid at 90% after you satisfy your annual deductible for the mother and the annual deductible for
the newborn (deductibles are accumulated separately).
For in-network PPO600 coverage, delivery and hospital stay is paid at 80% after you satisfy your annual deductible for the mother and the annual deductible for
the newborn (deductibles are accumulated separately); and after a $250 admission charge for the mother and a $250 admission charge for the newborn (mother and
newborn admission is separate).
For EPO coverage, delivery and hospital stay is covered at 90% for the mother and newborn; and after a $250 admission charge for the mother and a $250 admission
charge for the newborn (mother and newborn admission is separate).
Contact UnitedHealthcare at 1-800-520-0746 for details on your plan.
Extended Hospital Stay
Notification of Extended Hospital Stay is Required
Call UnitedHealthcare at 800-520-0746 and follow the prompts to reach Care Management.
If your newborn remains in the hospital after you are discharged, and you are in the PPO300, OOA300, PPO600 or OOA600, you must call UnitedHealthcare's Care Management at
800-520-0746 as soon as reasonably possible to notify them of your newborn's extended stay.
Notification is required to ensure that your baby receives the necessary and appropriate care for his/her condition. For those in the EPO, your Primary Care
Physician will arrange for notification to UnitedHealthcare.
Penalty for failure to notify Care Management of the newborn’s extended stay is outlined below:
- For services from in-network providers: a mandatory $500 penalty is applied for each extended inpatient admission.
- For services from out-of-network providers: benefits may be reduced by 50% or denied. In addition there is a mandatory $500 penalty applied for each inpatient admission.
- The penalty and the extra amount you pay does not count toward your deductible and out-of-pocket maximum. Call UnitedHealthcare at 800-520-0746 and follow the prompts to reach Care Management.
Enrolling Newborns For Immediate Coverage
Because newborn children are eligible for coverage from birth, you must follow the enrollment process to enroll them into the Enterprise health care plan.
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