Plan Documents
Use this tool for a quick link to the sections of the plan document.
What is the bookmark tool?
This is the easiest place to determine who is covered for maternity benefits on the plan.
What is the grid?
The acronym for a flexible spending account.
What is FSA?
The acronym for this is IOP.
What is intensive outpatient?
The preferred method (or tool) for quoting benefits.
What is the grid?
You can find the definitions the plan uses in this section of the plan document.
What is the definition section?
The percentage at which lactation support is covered in network on a non-grandfathered health plan.
What is 100%
The acronym for a healthcare reimbursement account
What is HRA?
This provides a structured program of outpatient psychiatric services as an alternative to inpatient psychiatric care. It’s more intense than care you get in a doctor’s or therapist’s office. This treatment is provided during the day and doesn’t require an overnight stay.
What is partial hospitalization?
A procedure, device, treatment or medication designed to prevent disease, guarding from or preventing the spread or occurrence of disease or infection.
What is prophylactic?
You can find the precertification requirements in this section of the plan document.
What is the medical management or cost management section?
The precertification rule that we follow for maternity
What is the 48/96 hour rule?
The acronym for a healthcare spending account.
What is HSA?
The law passed in 1996 that states that if mental health benefits are offered then they must be equal to the benefits for all other illness.
What is the Mental Health Parity Act?
Medical services that are not listed in the plan document at all.
What are silent benefits?
You can find the coordination rules in this section of the plan document.
What is the coordination of benefits section?
A type of billing where the provider bills all of their services after the baby is delivered.
What is global billing?
The amount that once met the covered percentage changes to 100%.
What is the out-of-pocket?
I can find the guidelines for what facilities qualify as hospitals in this section of the plan document.
What is the definition section?
The injection is given into the skin or muscle
What are intramuscular injections?
You can find the list of items that apply to the out-of-pocket maximum in this section of the plan document.
What is General overview of the plan section?
A service where a new mother is given support for breastfeeding.
What is lactation support?
The amount a member must pay before the plan will pay.
What is a deductible?
IOP and partial hospitalizations are both covered under this portion of the plan benefits.
What is outpatient services?
Use this to update the OIC when the other insurance is Medicare.
What is the Medicare Checklist?