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How Does Maternity Sharing Work
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How Does Maternity Sharing Work?

Zion HealthShare offers comprehensive maternity sharing as part of its medical cost-sharing model, with specific guidelines around what is shareable, limitations, and how the process works. Here’s an overview of maternity care under Zion HealthShare:

 

1. Eligibility for Maternity Sharing

  • To qualify for maternity sharing, the pregnancy must occur after the member’s start date. Conception that occurs prior to the membership start date is not eligible for sharing, and any related expenses won’t be shareable.

  • The maternity sharing request must be submitted no later than six months from the date of pregnancy confirmation. Late submissions may result in ineligibility for sharing.

  • Members pay a single Initial Unshareable Amount (IUA) for all expenses related to maternity, including prenatal care, delivery, and postnatal care.

 

2. Shareable Maternity Expenses

Once eligible, the following maternity-related expenses are shareable:

  • Prenatal Care:

    • Routine office visits

    • Routine lab work

    • Up to three standard ultrasounds (additional scans may be shareable in case of complications)

    • Fetal non-stress tests after 36 weeks

    • Screenings for sexually transmitted diseases (STDs/STIs) prescribed as part of routine prenatal care

  • Delivery and Birth:

    • Hospital labor and delivery, including Cesarean sections

    • Midwife services (with an itemized breakdown of costs)

    • Home births

    • Maternal fetal specialist consultations (if ordered by the pregnancy provider)

    • Anesthesiologist services

    • Birthing centers

  • Postnatal Care:

    • The mother’s six-week postpartum checkup (including a pap test)

    • Two-week Cesarean post-operative appointment

 

3. Newborn Care

  • One in-hospital pediatrician visit, routine immunizations, routine lab work, and hearing tests for the newborn are shareable when the baby is added to the household membership within 30 days of delivery.

  • If the newborn has any complications or medical needs after birth, a separate sharing request is required, and the newborn will have its own IUA.

 

4. Home Births

  • Home births typically incur fewer expenses than hospital births, and Zion HealthShare may partially waive the IUA for maternity sharing if the home birth expenses are significantly lower and the birth is overseen by a licensed care provider.

 

5. What is Not Shareable

  • Certain services and treatments are not eligible for sharing as part of maternity care:

    • 3D and 4D ultrasounds

    • Chiropractic services for babies in breech positions

    • Doula services

    • Birthing tubs and other delivery-related equipment

    • Circumcision

    • Non-prescription supplements

    • Breast pumps and lactation consultants

    • Postpartum counseling

    • Genetic testing, including amniocentesis, NIPT, and related counseling services

 

6. Special Circumstances

  • Premature Birth: Medical expenses related to a premature birth may be shared under the eligible maternity request. However, any services outside standard care for the newborn would require a separate sharing request.

  • Miscarriage: If a miscarriage occurs and the costs exceed the IUA, expenses related to it are shareable. If the miscarriage is not associated with an eligible maternity request, it falls under regular sharing guidelines.

  • Gestational Diabetes: This condition is considered a pregnancy complication, and expenses related to its treatment (including medications) can be shared under the prescription sharing guidelines.

 

7. Additional Guidelines

  • Members are encouraged to follow their healthcare provider’s recommendations, including diet and exercise, particularly in cases of complications like gestational diabetes.

  • Newborns not born in connection with an eligible maternity request must be added to the membership within 30 days of birth for their medical needs to be shareable.

 

In summary, Zion HealthShare provides extensive maternity sharing that covers most routine and emergency pregnancy-related care, with specific exclusions for non-essential services and conditions. Proper and timely submission of sharing requests is crucial to ensuring eligibility​.

Maternity Care at Zion HealthShare

Maternity Care?

Zion HealthShare provides extensive maternity sharing that covers most routine and emergency pregnancy-related care, with specific exclusions for non-essential services and conditions.

 

Proper and timely submission of sharing requests is crucial to ensuring eligibility

 

View our maternity guide by clicking here.

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