Huntington Ingalls Newport News Anthem Key ... - Benefits Connect

How your health plan works - 13
The length of stay for maternity admissions is determined according to the Newborn’s and Mother’s
Health Protection Act. This federal law allows for 48 hours for vaginal delivery or 96 hours for
caesarian section. Admissions for maternity care do not, initially, require Hospital Admission Review.
However, if complications develop and additional days are necessary, Hospital Admission Review is
required. We request that your doctor contact Anthem to establish eligibility and waiting periods.
Admissions to hospitals located outside of Virginia
If you are admitted to a hospital outside of Virginia, you or someone on your behalf must initiate the
Hospital Admission Review process. This applies in all cases, whether you live, work, or travel outside
of Virginia. If approval is not obtained for an inpatient stay and the stay is later determined by Anthem
not to be medically necessary, you may have to pay the entire hospital bill in addition to any charges
for services provided while you were an inpatient.
Individual case management
In addition to the covered services listed in this booklet, your health plan may elect to offer benefits for
an approved alternate treatment plan for a patient who would otherwise require more expensive
covered services. This includes, but is not limited to, long term inpatient care. Your health plan will
provide alternate benefits at its sole discretion. It will do so only when and for so long as it decides
that the services are medically necessary and cost effective. The total benefits paid for such services may
not exceed the total that would otherwise be paid without alternate benefits. If your health plan elects
to provide alternate benefits for a covered person in one instance, it will not be required to provide the
same or similar benefits for any covered person in any other instance. Also, this will not be construed
as a waiver of your health plan’s right to enforce the terms of your health plan in the future in strict
accordance with its express terms.
Also, from time to time your health plan may offer a covered person and/or their provider or facility
information and resources related to disease management and wellness initiatives. These services may
be in conjunction with the covered person’s medical condition or with therapies that the covered person
receives, and may or may not result in the provision of alternative benefits as described in the
preceding paragraph.
If you changed plans within the year
Your health plan may include calendar year limitations on deductibles, out-of-pocket expenses, or
benefits. These limitations may be affected by a change of health plan coverage during the calendar
year.
• If you change from one employer’s health plan to another employer’s health plan during the
calendar year, new limitations will apply as of your effective date of coverage under the new
employer’s health plan. Amounts that may have accumulated toward similar limitations under your
former employer’s health plan will not count toward the limitations under your new employer’s
health plan.