Blue Choice HMO Benefits - Harford County Public Schools

4. The facility and personnel providing the treatment are capable of doing so by
virtue of their:
a. Experience;
b. Training; and,
c. Volume of patients treated to maintain expertise;
5. There is no clearly superior, non-Investigational treatment alternative; and,
6. The available clinical or pre-clinical data provide a reasonable expectation that
the treatment will be at least as effective as the non-Investigational alternative.
D. Coverage is provided for Patient Cost incurred for drugs and devices that have been
approved for sale by the FDA whether or not the FDA has approved the drug or device
for use in treating the Member's particular condition, to the extent that the drugs or
devices are not paid for by the manufacturer, distributor, or provider of that drug or
device.
2.7 Maternity Benefits.
A. Maternity Services. Benefits are provided for all female Members including:
1. Obstetrical care, prenatal, delivery, postnatal care;
2. Coverage for a Hospital stay;
3. Coverage for care rendered by a CareFirst BlueChoice approved licensed birthing
center;
4. Collection of adequate samples for hereditary and metabolic newborn screening
and follow-up; and,
5. Newborn hearing screening prior to discharge.
B. Postpartum Home Visits. Home visits following delivery are covered in accordance with
the most current standards published by the American College of Obstetricians and
Gynecologists.
1. For a mother and newborn child who have a shorter Hospital stay than that
provided under Section 3.2.D, Number of Inpatient Hospital Days Covered,
benefits will be provided for:
a. one home visit scheduled to occur within 24 hours after Hospital
discharge; and
b. an additional home visit if prescribed by the attending provider
2. For a mother and newborn child who remain in the Hospital for at least the length
of time provided under Section 3.2.D, Number of Hospital Days Covered,
benefits will be provided for a home visit if prescribed by the attending provider
C. Birthing Classes. Birthing classes are covered, one course, per pregnancy at a CareFirst
BlueChoice approved facility.
MD/GHMSI/CFMI BC (R. 10/10)
CareFirst BlueChoice
Harford County Public Schools 12 7/1/2011