Medi Cal qualification for Pregnant Women

Group Employer Plans

Maternity coverage is mandatory on GROUP and INDIVIDUAL policies beginning in July 2012 in CA^{(Siders [1], “Capitol Alert,” Sacramento Bee, 10/6). californiahealthline.org  SB 222 AB 210  Insurance Code 10123.865}

Maternity in most cases can’t be excluded  as a  Preexisting Condition   in a Group policy.  Nor can a newborn who has applied for coverage … within 30 days of birth; or  A child who is adopted … within the 30 days.   ^{Insurance Code §10708 d3      26 U.S.C.A. section  §9801(d)3;    Cal. Health and Safety Code section  §1357.51  g 3}  

Federal & State Family Leave Act

Guaranteed Coverage for  Employer Group of 2

No individual or group policy of health insurance that is issued, amended, renewed, or delivered on or after July 1, 2003, that provides maternity coverage shall contain a copayment or deductible for inpatient hospital maternity services that exceeds the most common amount of the copayment or deductible contained in the policy for inpatient services provided for other covered medical conditions or contain a copayment or deductible for ambulatory care maternity services that exceeds the most common amount of the copayment or deductible contained in the policy for ambulatory care services provided for other covered medical conditions.  ^{CA Insurance Code 10119.5.  (a) SB  1411 2002}

The Newborns’ and Mothers’ Health Protection Act of 1996 new protections for mothers and their newborn children with regard to the length of the hospital stay following childbirth  ^{Q & A Page 31} CA Health & Safety Code § 1367.69(a)…obstetrician gynecologists- must be eligible as primary care physicians (PCP) – that means you can schedule an appointment with your OB/GYN without going to your PCP first, in the same Medical Group/IPA.  Provider Finder Standards relating to benefits for mothers and newborns ^{IRS Code § 9811.}

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SDI

Historical Information

Medi-Cal  With Health Care Reform, this page is pretty much out of date.  Click here for GUARANTEED issue quotes and subsidies.

California AIM (Access for Infants and Mothers)  provides coverage for women who are already pregnant and need maternity insurance coverage. You can apply up to the 30th week. Even if you have other Health Insurance, as long as it has a deductible or Co Pay of at least $500^{.CA Insurance Code 12695 et seq.} AIM Program Handbook: 50 pages and includes the five-page Application. Be sure to put in our Agent’s Information How much is the Premium? aim.ca.gov/Costs/ embrace a child.org/

ACCESS FOR INFANTS AND MOTHERS GENERAL PROVISIONS AND DEFINITIONS

General ……………………………….. 12695-12695.24

POWERS AND DUTIES OF THE BOARD Administration …………………………. 12696-12696.20

Advisory Panel ……………………………….. 12696.5

PARTICIPATING HEALTH PLANS ……………… 12696.7-12697.15

SUBSCRIBER ELIGIBILITY AND ENROLLMENT

Eligibility and Coverage ………………… 12698-12698.35

Unfair Competition and Labor Practices …. 12698.50-12698.56

PERINATAL INSURANCE FUND …………………. 12699-12699.05

OPERATION OF PROGRAM 10123.865.  (a) Commencing no later than July 1, 2012, every Including Grandfathered plans ^{Per Blue Cross email dated 4.19.2012} individual health insurance policy shall provide coverage for maternity services for all insured’s covered under the policy. (b) For purposes of this section, “maternity services” include prenatal care, ambulatory care maternity services, involuntary complications of pregnancy, neonatal care, and inpatient hospital maternity care, including labor and delivery and postpartum care.

This definition of “maternity services” shall remain in effect until such time as federal regulations and guidance issued pursuant to the federal Patient Protection and Affordable Care Act (Public Law 111-148) aka Obamacare define the scope of benefits to be provided under the maternity benefit requirement of that act, after which time the definition of that term under the federal act and associated regulations and guidance shall apply for purposes of this section. Bookmarks

CA all policies must include maternity