Summary Plan Description
90% Network and 80% Non-Network
Female Participant or Dependent Spouse
Benefits are provided for services and supplies for pregnancy-related conditions for the female participant or the participant's spouse. Covered pregnancy-related conditions include normal delivery, cesarean section, spontaneous abortion (miscarriage), legal abortion, and complications of pregnancy subject to the maximum allowable fee. Covered services and supplies include:
- Outpatient and inpatient hospital prenatal and postnatal care.
- Prenatal diagnosis of congenital disorders of the fetus by means of screening and diagnostic procedures during pregnancy. Genetic testing must be precertified.
- Childbirth in an approved birthing center that is licensed as required by the state in which it operates.
Pregnancy care by a physician or certified nurse midwife is covered under this benefit. A licensed midwife may also be covered but certain restrictions apply. Contact Carpenters Trusts for more information or use a licensed network midwife.
All inpatient admissions must be precertified with Aetna at (888) 632-3862. No hospital stay in connection with childbirth, either for the mother or for the newborn child, may be limited to less than 48 hours following a vaginal delivery or less than 96 hours following a cesarean section, unless there is an agreement between the mother and the attending physician that the length of stay shall be less than the above periods. The plan will not provide coverage, or may apply the precertification penalty, if the mother or newborn remains in the facility more than the minimum length of stay (as described above) without precertification under the precertification procedures.
Benefits are not provided for:
- Postpartum home help or visits.
- Pregnancy related charges incurred by a covered person who is a surrogate mother for another party, or for a person who acts as a surrogate for a person covered under this plan.
- A dependent daughter's pregnancy or resulting childbirth, miscarriage or abortion including complications thereof, except as provided below for prenatal care under the Women's Preventive Care Act.
Benefits are provided for services and supplies for routine newborn care for a dependent child during the child's initial confinement at birth. The newborn must satisfy his or her annual deductible and coinsurance requirements. Covered services and supplies include:
- Routine hospital services and supplies while the mother is in the hospital.
- Physician services.
- Circumcision during the initial hospitalization or in the physician's office thereafter.
Remember to enroll your newborn in this plan as soon as possible as described. Claims cannot be processed until the child is enrolled in the plan.
Services are not provided for any charges related to a child of a covered person acting as a surrogate mother for another party.
Benefits are provided to a dependent daughter for prenatal services during pregnancy that are listed under the Women's Preventive Care Act. Please refer to www.healthcare.gov/preventive-care-benefits/ for additional information.
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