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Maternity Plan

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Maternity Plan Details

DISCONTINUED - GO TO OUR OTHER MATERNITY PAGE

THE NOWCARE PPO PLUS PLAN HAS BEEN DISCONTINUED. IT HAS PROVIDED ASSISTANCE WITH MATERNITY EXPENSES FOR QUITE SOME TIME. WE ARE SORRY TO SEE IT GO.

An Explanation of the NowCare PPO Plus and How it is Used for Maternity Coverage - DISCONTINUED - GO TO OUR OTHER MATERNITY PAGE

IMPORTANT NOTE: If you have the prior 12 months of coverage, you can wait until you know you are pregnant to take this plan. They will not take you past the 3rd month but it will save you a lot of money in premiums.

We use limited benefit plans to cover pregnancy. These are plans that pay out fixed amounts according to a schedule. The plan pays these amounts for doctor visits, lab tests, hospital stays and so on. They do not care if you are at a doctor’s appointment or hospitalized for maternity or because you are having your tonsils out. To them, a doctor visit is a doctor visit. They are all the same.

Let me give you an example. If you look on the benefit chart for one of our plans (NowCare Plus) you will see that it pay out $2,000 a day for a hospitalization for each of the first three days. After that, it pays out $1,000 a day.

Remember, you must either obtain this plan before you are pregnant or have other health insurance in effect when you apply.

Doctor Visits

This plan will pay either you or your doctor $100 for six visits per calendar year. Clearly, you will have more than six visits if you are pregnant. But, it will still reimburse you the $600 each calendar year.

Since this is NOT a maternity plan, you need to understand how doctor visits are reimbursed.

The plan pays for "non-well" visits. This means that the code your doctor's office uses to describe the visit, cannot indicate that you were there for a checkup. Explain this to the insurance person in the office. Tell them "My plan will pay out for non-well visits. If you use a code on the bill that describes a check-up or "well visit", I will not get any money from the plan for the visit.

Testing

The plan will pay out up to $125 for a diagnostic test or x-ray (such as a sonogram). Your potential reimbursement is $375 per calendar year. Again, it is a good chance that between sonograms and blood tests you will have more than three tests. 

Remember, this is for a "diagnostic" test or x-ray. It is not for a well visit exam test.

Hospital

This plan pays out $2,000 a day for each of the first three days and then $1,000 a day for the next 27 days. If you are hospitalized for two days (normal delivery), the plan will pay out $4,000. If you are in the hospital for 4 days (c-section), the plan will pay you $7,000.

Surgical Fee

There is also payment for surgery of $2,000 once per year.

PPO Network

The plan uses the Multiplan PPO network and you are entitled to the PPO discounted rate for all services. A provider in the network (physician, lab or hospital) will be able to go online and actually see your benefits, the amount they can charge and initiate payment. This is similar to traditional major medical plans in that respect.

Global Billing

Obstetricians often use a global billing method. They charge a single fee that includes office visits, tests and their services to deliver the baby.

However, this plan is not a maternity plan and expects to see claims in the same format they would see a visit for a cold, an ear infection or any other sick visit.

You need to expalin to the insurance person at your OB that you will need to file a claim form for the first six visits that show a dollar amount and a "code" that shows it was a non-well visit. Most offices have someone who will understand what you are talking about. Otherwise, have them call me. Again, make sure it is not a well-visit or check-up.



Our number is 800-272-0512 and we are available from 9 am to 8 pm EST.

 

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