CALIFORNIA - Pacificare Health Systems

plan, including the applicable Health Plan
Premiums, at any time after sending written
notice to your former employer, up to 60 days
prior to the effective date of any amendment
or modification. Your former employer may
also change your health plan benefits during
the contract year. Your former employer is
obligated to notify Retirees who are Secure
Horizons Group Retiree MA Plan Members of
any such amendment or modification.
Newborn’s and Mother’s Rights Act
Prenatal and maternity care services are
covered, including labor, delivery and recovery
room charges, delivery by cesarean section,
treatment of miscarriage and complications
of pregnancy or childbirth. A minimum
48-hour inpatient stay for normal vaginal
delivery and a minimum 96-hour inpatient
stay following delivery by cesarean section
are covered. Coverage for inpatient hospital
care may be for a time period less than the
minimum hours if the treating Physician in
consultation with the Member makes the
decision for an earlier discharge of the mother
and newborn. In addition, if the mother and
newborn are discharged prior to the 48- or 96hour
minimum time periods, a post-discharge
follow-up visit for the mother and newborn
will be provided within 48 hours of discharge,
when prescribed by the treating Physician.
Under the Secure Horizons Group Retiree
MA Plan coverage, newborns are not eligible
dependents. Newborn care will be the financial
responsibility of the Retiree. Please contact
your former employer to arrange health plan
benefits for your newborn dependent.
Women’s Health and Cancer Rights Act
Medically Necessary mastectomy and lymph
node dissection are covered, including
prosthetic devices and or reconstructive
surgery to restore and achieve symmetry
for the Member incident to the mastectomy.
The attending Physician and surgeon in
consultation with the Member, consistent
with sound clinical principles and processes,
determine the length of a hospital stay.
Coverage includes any initial and subsequent
Section 15 – Addendum
reconstructive surgeries or prosthetic
devices for the diseased breast on which
the mastectomy was performed. Coverage is
provided for surgery and reconstruction of the
other breast if, in the opinion of the attending
surgeon, this surgery is necessary to achieve
symmetrical appearance. Medical treatment
for any complications from a mastectomy,
including lymphedema, is covered.
Questions? Call the Customer Service Department at 1-800-228-2144,
(TDHI) 1-800-685-9355, Monday through Friday, 7:00 a.m. to 9:00 p.m.
221
PART B