Maternity Flyer - South Carolina Public Employee Benefit Authority

Having a Baby with
PEBA Insurance
Maternity Care
State Health Plan
Regular prenatal care and following your doctor’s
recommendations can help keep you and
your baby healthy. If you are a mother-to-be, you
must participate in the Maternity Management
Program. The program monitors expectant
mothers throughout pregnancy and manages
Neonatal Intensive Care Unit (NICU) infants or
other babies with special needs until they are one
year old. To preauthorize your maternity benefi ts,
you must notify Medi-Call during the fi rst trimester
(three months) of your pregnancy. You do not
have to wait until you have seen your physician.
If you do not notify Medi-Call of your
pregnancy during the fi rst trimester, or if you
refuse to participate in the Maternity Management
Program, you will pay a $200 penalty
for failing to call as well as a $200 penalty for
each maternity-related inpatient admission.
You also will incur a coinsurance penalty.
From there, you will be asked to select the member.
You will then be taken to the home screen
of the Personal Health Record, which will bring
up “My Activity Center.” In the “My Assessments”
box, select “Initial Maternity.”
BlueChoice HealthPlan HMO
You and your covered spouse are covered for
hospital care, hospital-based birthing center care,
and prenatal and postpartum care, including
childbirth, miscarriage and complications related
to pregnancy. Inpatient benefi ts are provided for
the mother and newborn for 48 hours after normal
delivery, not including the day of delivery, or
96 hours after caesarean section, not including
the day of surgery. Coverage for the newborn
includes, but is not limited to, routine nursery care
and/or routine well-baby care during this period
of hospital confi nement. Charges for home births
are not covered. Pregnancy is not considered a
pre-existing condition.
You can also notify Medi-Call of your pregnancy
and enroll in “Coming Attractions” online through
the Personal Health Record’s maternity screening
program. Go to the PEBA Insurance Benefi ts
website, www.eip.sc.gov. Under “Links,” select
“Medical (BlueCross BlueShield of South Carolina).”
At the site, select “My Health Toolkit” and
then log in and select “Personal Health Record.”
South Carolina Public Employee Benefit Authority
Insurance Benefits
803-734-0678 (Greater Columbia area)
888-260-9430 (toll-free outside the Columbia area)
THIS OVERVIEW IS NOT MEANT TO SERVE AS A
COMPREHENSIVE DESCRIPTION OF THE BEN-
EFITS OFFERED BY THE PUBLIC EMPLOYEE
BENEFIT AUTHORITY.
12/2012

After Your Child is Born
Newborns are not automatically enrolled in coverage.
When your baby is born, contact your benefi
ts offi ce within 31 days to add the child to your
coverage.
At this time, you may also choose to enroll in or
increase your Optional Life insurance, without
medical evidence, in $10,000 increments up to
$50,000. You may also make adjustments to your
Flexible Spending Accounts. Ask your benefits
administrator for more information.
Documentation Requirements
In addition to the enrollment form, you will be
required to provide a copy of your child’s longform
birth certifi cate to your benefi ts administrator
at the time of enrollment. The hospital will give
you the application for a birth certifi cate before
you are discharged. Be sure to request the long
form. PEBA Insurance Benefi ts requires this form
because it includes the names of the parents.
The hospital is required to report the birth to the
S.C. Department of Health and Environmental
Control (DHEC) within fi ve days. DHEC mails the
birth certifi cate to the parents within two to three
weeks.
If a provider requires proof of insurance, PEBA
Insurance Benefi ts will accept an offi cial document
from the hospital instead of the birth certifi
cate. The document must include the child’s
name, date of birth and parents’ names. It must
be signed by the attending physician or a hospital
staff member.
Even if you do not have the documentation, you
must complete an enrollment form to add your
child within 31 days of birth.
If you have any questions about enrollment, contact
your benefi ts offi ce or the Employee Insurance
Program.
Well Child Care
Well Child Care benefi ts are designed to promote
good health and aid in the early detection
and prevention of illness in children enrolled
in PEBA Insurance Benefi ts health plans. For
information on the Well Child Care benefi ts offered
by your plan, visit the Prevention Partners
area of PEBA Insurance Benefi ts’ website,
www.eip.sc.gov/prevention, and choose
“Wellness and Preventive Benefi ts” from the
left-hand menu.
PEBA Insurance Benefi ts must have documentation
to enroll the child. Don’t worry; most providers
will render services to a newborn without
proof of insurance. Once the documentation is
received, the coverage will be effective on the
child’s date of birth, and the providers will be able
to submit claims for services.
12/2012