Taking Care Of Your Health During Pregnancy
Life changes you when you become a mom. Maybe youll become a new mom through pregnancy. Others may become new moms by being a foster parent or through adoption. If your path to becoming a mom includes pregnancy, you might be wondering what surprises await you and how best to prepare for whats ahead before your baby arrives. Here are some resources to help you along the way.
My Attending Provider Discharged Me In Less Than 48 Hours Is This Permissible
Yes. Under the Newborns Act an attending provider, after consulting with a mother, can discharge a mother or newborn in less than 48 hours. Your attending provider, after consulting with you, can decide to discharge you or your newborn earlier. However, it is not permissible for your plan or insurance company to offer you incentives to induce you to accept less than the minimum protections available to you under the Newborns Act. Further, it is not permissible for your plan or insurance company to provide incentives to induce your attending provider to discharge you or your newborn earlier than the minimum 48 hours after delivery .
Your Protections Under The Health Insurance Portability And Accountability Act
If you are eligible but not enrolled in an employers health plan, you may enroll yourself, your spouse, and your new child upon the birth, adoption, or placement for adoption of a new child. This is referred to as special enrollment.
Special enrollment is available regardless of whether the employer offers open season, or when the next open season might otherwise be.
To be eligible, you must request special enrollment in the plan within 30 days of birth, adoption, or placement for adoption. Check with your plan administrator, or check your plans summary plan description to find out if the plan has special procedures for requesting special enrollment.
Coverage for special enrollees is effective retroactive to the date of birth, adoption, or placement for adoption.
Special enrollees must be treated the same as similarly situated individuals who enrolled when first eligible. They cannot be treated as late enrollees therefore, the maximum preexisting condition exclusion that can be imposed on a special enrollee is 12 months, reduced by prior creditable coverage.
Most health coverage is creditable coverage, including most coverage under a group health plan , group or individual health insurance coverage, Medicare, Medicaid, TRICARE, Indian Health Service, state risk pools, Federal Employees Health Benefit Plan, public health plans, Peace Corps plans, and State Childrens Health Insurance Programs.
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If You Have An Employer
If you have insurance through an employer, your baby will be automatically covered for a set period immediately after birth. Notify your insurer, or your human resources or benefits department, within 30 days of the babys arrival to add them onto the insurance plan.
Your baby will be enrolled retroactively as of their birth date and cant be rejected for preexisting conditions. Any medical care they get in those early days will be covered if you sign up in time, even for services received before you signed up.
Some employers offer extra time to enroll a newborn. Check your companys rules.
If you and/or your dependents are covered under Medicaid or a state Child Health Insurance Program but lose eligibility for that coverage, you have up to 60 days from the date you lose coverage to enroll in your employers plan.
During the Covid-19 pandemic, the U.S. Department of Labor and the Internal Revenue Service published a rule1 waiving certain timeframes, such as the deadlines for enrolling a newborn on a group health insurance plan. The rule will last until 60 days after the national public health emergency ends, or until a date determined by federal agencies.
The pandemic conditions are ever-changing, so check the current rules. That way, you know how long you have to add your baby to your health plan.
Replacing Your Medicare Card Just Got A Whole Lot Easier
The Social Security Administration recently made it a whole lot easier for Medicare beneficiaries to replace their Medicare identification cards.
If your card has been lost or damaged and you need to request a replacement card, log in to your my Social Security account to request a new one. Your replacement card will arrive in the mail in about 30 days.
if you dont have a my Social Security account and you need help to create one.
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Certification Does Not Guarantee Coverage
Certification of a hospital admission means that The Empire Plan Benefits Management Program has found the inpatient setting appropriate. This certification does not guarantee coverage. The Empire Plan program administrators will determine eligibility and benefits as part of the claims review process. For example, although the inpatient setting may be certified for your spouse’s surgery, benefits are not available if you discontinued his or her coverage before the admission. As another example, if the hospital setting was approved for surgery that the program administrators later determine to be cosmetic surgery or an experimental or investigative procedure, benefits are not available. The Empire Plan does not cover cosmetic surgery and experimental or investigative procedures or related hospital care. Call the Hospital Program or the Medical Program if you have questions about benefits for hospitalization or a certain procedure.
Medicare Annual Enrollment Period
You can join, switch or drop a Medicare Advantage or Medicare prescription drug plan during the Medicare Annual Enrollment Period . AEP is October 15 to December 7. Since it’s the same time every year, you always know exactly how many shopping days you have until you can add or switch coverage during AEP.
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Change My Health Plan
Most Washington Apple Health eligible individuals receive their coverage through a managed care plan.
If you’re currently enrolled in an Apple Health managed care plan, you can switch to a different plan available in your area. Depending on when you make your request, your new plan will usually start the first of the next month. View the managed care FAQ for more information.
The Health Care Authority offers five health plans that provide services to our Apple Health clients. Not all plans are available in all areas.
- Amerigroup Washington
- Community Health Plan of Washington
- Coordinated Care of Washington
Important Information For New Or Soon
If you have health coverage and are pregnant, you and your new child may be entitled to a 48-hour hospital stay following childbirth . If your employer or your spouses employer offers a health plan, birth, adoption, and placement for adoption may also trigger a special enrollment opportunity for you, your spouse, and your child, without regard to any open season for enrollment.
The Affordable Care Act adds important protections related to employment based group health plans that will improve health coverage for you and your family. Many of these protections are available now including extending dependent coverage until age 26, prohibiting preexisting condition exclusions for children under 19, and banning lifetime limits on coverage for essential health benefits. Additional protections will be available in 2014. This publication does not reflect the provisions of the Affordable Care Act. For more information, visit the Employee Benefits Security Administrations ACA Web page at dol.gov/ebsa/healthreform.
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Helping You Prepare For A Healthy Pregnancy
Video transcript
WOMAN 1: I always wanted to be a mom, so I was thrilled when I found out I was pregnant.
WOMAN 2: I was 17 when I found out I was pregnant with my daughter.
WOMAN 3: For the first few months, I didn’t even know how to tell my mom.
WOMAN 1: But then, nothing went as planned. My marriage ended before my son was born and I didn’t have anyone to turn to.
WOMAN 2: Suddenly, I was responsible for another person.
WOMAN 1: Even as a nurse, it was hard to accept that I had postpartum depression.
WOMAN 2: Having a baby is exciting, but you need a team. Friends and family are important, but make sure a nurse or a doctor are a major player on your team.
WOMAN 3: I’ve worked with enough pregnant women to know that prenatal appointments help catch complications, whether you have symptoms or not.
WOMAN 2: Whether this is your first child or you’ve been down this road before, schedule your prenatal appointment at eight weeks or as soon as you find out you’re pregnant. It’s essential for your health and your baby’s.
WOMAN 3: Your care provider can also help connect you with resources like diaper and healthy food programs.
WOMAN 1: And don’t forget your postpartum appointment, it’s so important to take care of yourself, too. Check in with your doctor two weeks and six weeks after you give birth to discuss how you’re feeling.
WOMAN 3: Visit everypregnancy.com for resources to answer your questions and help you prepare for a healthy pregnancy.
WOMAN 1: We are here for you.
Company: United Healthcare & Walmart
Support and resources for:
Customer Service Support Phone Number is:
1-833-845-8798, TTY 711
This company has partnered with Walmart to allow Eligible Members to make better use of their Over-The-Counter Benefit. Eligible Members of UnitedHealthcare will save on many over-the-counter health items! The sponsored program they have created is called: Healthy Benefits Plus.
Healthy Benefits Overview:
This number is for questions and assistance regarding Healthy Benefits Plus. However, if you have questions about your health insurance plan or coverage, please call the number found on your current health plan ID card. You must be an eligible United Healthcare member to register for Healthy Benefits Plus. Use the programs website to access your OTC benefits anywhere, anytime.
Online Access
You can instantly redeem your benefits on qualifying products with your card number or barcode when you are ready to checkout. It is a very easy online process. To view your benefit information and get details on how to shop, see below. You can also find your program website information in the welcome materials that were sent to you in the mail. Be sure to review your welcome materials or login to your program website for a full description of benefits and shopping options.
Need Medicare or Health Insurance?
What is the United Healthcare Over-The-Counter Benefit?
Why use the UHC OTC Benefit?
You may choose from three different ways to shop:
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If You Experience A Qualifying Life Event Sign Up Right Away
In most situations, youll need to make changes to your health plan within a specific time frame of the qualifying life event. Missing this deadline could mean having to wait until the next open enrollment, which could be as long as a year. For more information, check your plan materials or contact your employer.
If youre between enrollment periods and havent experienced a qualifying life event, short term health insurance is an option to bridge the gap. That way, you can help assure that youre not without insurance at any point.
The Benefits Management Program And The Mental Health And Substance Abuse Program
The Benefits Management Program does not replace The Empire Plan Mental Health and Substance Abuse Program. Call The Empire Plan and choose the Mental Health and Substance Abuse Program before seeking care for mental health and substance abuse problems, including alcoholism.
At times, a person’s condition may be so complicated that it is difficult to determine if the required care is medical or mental health/substance abuse related. If you cannot decide, call either the Mental Health and Substance Abuse Program or the Benefits Management Program for help determining which program applies.
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High Risk Pregnancy Program
The Empire Plan Benefits Management Program offers special help for pregnancies. Call The Empire Plan and choose the Hospital Program as soon as you know you’re pregnant. The Benefits Management Program will help identify possible problems and will work with you and your doctor. See the following for details.
Update Your Information With Profile & Settings
In the portal, you can simply click on your name in the top-right corner to view Profile & Settings. You’ll be able to update and select:
- Account Information & Job Function Where you can check your current access
- Organization & Tax ID Access View which tax IDs you’re authorized for
- Communication Preferences Adjust where you’d like portal communications, such as security codes etc., to be sent
- Request Access Where you can send a request to your manager for additional access
- Reactivate Training Tips See on-screen training support for quick reference
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What Exactly Is A Qualifying Life Event
A qualifying life event is a big life-changing situation sometimes planned, sometimes unexpected that can impact you and your health insurance. Experiencing a significant life change may allow you to change your health plan outside of the annual enrollment period .
Qualifying life events include :1
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Having or adopting a baby
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Getting married
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Moving to a new area
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Experiencing a shift in employment status
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Turning 26
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Death of someone who shares your health plan
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Earning U.S. citizenship
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Turning 65
Preadmission Certification For Skilled Nursing Facility Admission
You must call The Empire Plan and choose the Hospital Program for precertification before admission to a skilled nursing facility, including transfer from a hospital to a skilled nursing facility. By calling prior to admission, you will know whether your care in a skilled nursing facility meets the criteria for Empire Plan benefits. Also, if your stay is precertified, you, your doctor, and the facility will be notified no later than the day before your certification for skilled nursing facility care will end.
If The Empire Plan is your primary coverage, skilled nursing facility care is covered under The Empire Plan if:
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The care in a skilled nursing facility is medically necessary. Care is medically necessary when it must be provided by skilled personnel to assure your safety and achieve the medically desired result and
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Inpatient hospital care would have been required if care in a skilled nursing facility were not provided.
If the above conditions are not met, the skilled nursing facility care is not covered under The Empire Plan.
Custodial care, which is primarily assistance with the activities of daily living, is not covered under The Empire Plan.
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Why Switch Plans
Coverage and costs can change from year to year. Your health care or budget needs could, too. If you have a Medicare Advantage or prescription drug plan, you should get information every fall that explains any changes in the plan’s benefit coverage, costs, or service area for the next plan year. Will your plan still meet your needs after the changes take effect? If not, you should think about switching plans.