Your Health Care Benefits

Gynecological Care and Maternity

Benefits for gynecological and maternity care are payable on the same basis as expenses resulting from an illness. After you have satisfied your annual deductible, covered charges made by a surgeon or a physician are payable at 80% of the allowance. If you have participated in the free “Healthy Pregnancy Program” offered through UHC, benefits are payable at 85% (rather than 80%) of the allowance for delivery charges by the obstetrician. For information about child wellness visits and immunizations, see here. Dependent children are not eligible for maternity care.


Fast Facts

  • For inpatient maternity and gynecological care, the Plan pays 100% of the allowance for hospital charges up to $7,000. After that, the Plan will pay 80% of the allowance.
  • UHC offers a prenatal education and information program to all EWTF members and spouses called the “Healthy Pregnancy Program,” which qualifies a participant for coverage at 85% of the allowance for the delivery charges of the obstetrician.
  • The Plan provides annual wellness exams for women at 80% of the allowance after the annual deductible is met.

What You Need To Do

  • Contact UHC at 800-850-1418 as soon as you or your spouse’s pregnancy is confirmed to receive free pre-natal care information through the “Healthy Pregnancy Program.” See here for more information.
  • If you have any questions regarding maternity benefits or payment of claims, please contact an EWTF Service Representative at (301) 731-1050.

Gynecological Care

EWTF encourages women to have an annual wellness exam. The Plan provides the following at 80% of the allowance after you’ve met your annual deductible:

  • one routine pap smear per year and related office visit
  • one mammogram per year for women age 35 or older

Mastectomy and Breast Reconstructive Surgery

In accordance with the Women’s Health and Cancer Rights Act of 1998, this Plan will provide the following coverage for a Participant or Dependent who is receiving benefits in connection with a mastectomy and who elects breast reconstruction surgery following such mastectomy:

  • reconstruction of the breast on which the mastectomy has been performed
  • surgery and reconstruction of the other breast to produce a symmetrical appearance
  • prosthesis and physical complications for all stages of the mastectomy, including lymphedemas

"Healthy Pregnancy” Maternity and Pre-Natal Healthy Baby Program

UHC provides a prenatal education and information program to all EWTF members and spouses. The objective of this program is to promote good health for mother and child, and to reduce the incidence and severity of Neonatal Intensive Care Unit needs by identifying high-risk pregnancies and enrolling members into specialized obstetrical case management. The Plan covers allowable delivery charges for the attending obstetrician at 85% (rather than 80%) for those participants who have participated in this “Healthy Pregnancy Program.” Call the Healthy Pregnancy Program at 800-850-1418 for more information on this benefit.

Newborn Wellness Exams

Routine wellness exams of newborns prior to their discharge from the hospital (or a similar period for delivery outside a hospital) are covered in full, and no deductible applies.

Maternity

Maternity care expenses can include emergency care, charges by physicians and surgeons in or out of the hospital, assistants or co-surgeons, and anesthesiologist’s charges.

Hospital Expenses for Maternity and Nursery

The first $7,000 of eligible expenses for room and board and other hospital services are paid in full (100% of the allowance, no deductible applies). For expenses in excess of $7,000, the plan will pay 80% of the allowance. Upon birth, the newborn child becomes an eligible dependent and therefore is entitled to coverage for $7,000 of eligible expenses, plus 80% thereafter. This coverage applies in addition to the coverage that the mother receives.

Pre-Natal Vitamins

The Plan will cover certain prescribed prenatal vitamins provided that they do not contain mineral supplements. To find out if your prescribed vitamins are covered, call the Fund Office at 301-731-1050 or at 1-800-929-3983.

Obstetrician’s Charges

The physician’s charges are paid at 80% of the allowance after you’ve satisfied your annual deductible. If you participated in the “Healthy Pregnancy Program,” the benefits are paid at 85% once the annual deductible is met.

Charges for global obstetrical/pregnancy services (antepartum care, delivery, and postpartum care) are paid after the birth of the child.

Services of a Midwife

The Plan pays 80% of the allowance for obstetrical services for delivery at home by a midwife. The midwife must be a certified nurse, work through a medically directed service organization and be under the direct supervision of a board certified Obstetrician-Gynecologist throughout pre-natal care, delivery, and during postpartum care. If the services of a nurse-midwife are used, no benefits are payable for charges by an obstetrician unless required due to complications.

Duration of Hospital Stay Following Childbirth

Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain prior authorization from UHC or issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).

What’s Not Covered

  • in-vitro fertilization, artificial insemination, or other treatment of infertility, or services to reverse tubal ligation, vasectomy, or other voluntary, surgically-induced fertility
  • abortions, unless justified by a physician as medically appropriate to protect the life of the patient, or with prior written approval of the Fund Office, when certified in writing by a physician who is board certified in obstetrics and gynecology prior to performing the procedure, that the fetus suffers from a severe performing disability which is likely to affect seriously the quality of life of the child if the pregnancy were carried to term
  • charges incurred by a dependent child in connection with pregnancy, childbirth, miscarriage or related medical condition