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mastectomy,
including lymphedemas. This coverage will be provided in a manner
determined in consultation with the attending physician and the
patient, subject to the
Fund’s general provisions relating to benefits, precertification
and other applicable
limitations. This coverage is also subject to the Fund’s annual
deductibles and
coinsurance provisions. If you have any questions about these
coverages,
please
contact the Fund Office.
BENEFITS
FOR MOTHERS AND NEWBORN
Under
federal and state law, when you or your dependent spouse enter
the hospital to give birth, the Fund will provide benefits for
a hospital stay of at least
forty-eight (48) hours following birth if the birth is a normal
vaginal delivery. The Fund
will provide benefits for a hospital stay of at least ninety-six
(96) hours following birth if
the birth is by caesarian section. You will still be responsible
for any deductibles or
copayments required under the Independence Blue Cross plan you
have selected.
The Fund
may provide benefits for a shorter stay if your attending
provider, in consultation with you, decides to discharge you earlier
than 48 (or 96) hours after you give birth. You may, of course, elect to leave the hospital
earlier than 48 or 96
hours after birth.
The Fund
(as well as any insurance provider): - cannot deny you
or your
child eligibility to enroll or to continue coverage under this
Plan to avoid paying for the
hospital stays described above; - cannot give you or your
attending provider any
financial or other incentives to encourage you to accept a shorter
stay in the hospital
than the stays described above; - cannot limit the amount
it pays your attending
provider because the attending provider determines that you should
be in the hospital
for 48 or 96 hour periods described above; and - cannot pay
lesser benefits or require
greater out-of-pocket costs for the 48 or 96 hour hospital stay
for the period after birth
than it pays for any hospital stay you have prior to the birth.
The Fund may not, under
federal law, require that a physician or other health care provider
obtain authorization
for prescribing a length of stay of up to forty-eight (48) hours
(or 96 hours). However, to
use certain providers or facilities, or to reduce your out-of-pocket
costs, you may be
required to obtain precertification.
CONTINUATION
COVERAGE IF YOU TEMPORARILY SERVE
IN THE ARMED SERVICES
General.
The Fund will provide continuation coverage pursuant to the
terms of the Uniformed Services Employment and Reemployment Rights
Act
("USERRA"), 38 U . S . C . 4301 et seq., for all leaves
while you are serving in the
uniformed services beginning on or after October 13, 1994. The
Fund will provide
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