General Maternity Flashcards
Maternity needs are shared when the doctor’s estimated due date is ____ days or more after the ______________________.
260
date the mother’s membership began.
What kind of membership(s) are required for maternity sharing?
A multi-person size (or at an equivalent monthly share amount when multi-person is not possible or practical) at least 260 days prior to the physician-calculated due date. Must both be in the same (Classic or Basic) program
In general, shareable maternity needs include bills for these 5 areas:
- Prenatal care
- Delivery
- Postnatal care
- Miscarriage
- Congenital conditions.
Shareable services include services provided by these practitioners:
- Doulas (up to $500)
- Midwives
- Nurse Practitioners
- Doctors
- Other licensed medical professionals.
Pregnancy and birth-related complications:
Do birth complications for the mother require a separate need?
No. These are shared as a part of the maternity need.
Pregnancy and birth-related complications:
For the child, what (if anything) is shared as part of the mother’s maternity need?
Pre-birth needs & routine postnatal care of the child, including no more than one routine outpatient doctor visit, will be part of the mother’s maternity need.
Pregnancy and birth-related complications:
For the child (single birth), what (if anything) would require a separate need for the child?
A post-birth need of the child beyond routine natal care will be considered the child’s need separate from the mother’s maternity need.
Pregnancy and birth-related complications:
For multiple births, what (if anything) would require separate needs for the children?
Complications (anything beyond routine natal care) from, or as a part of, a multi-child pregnancy, the expenses for each child will be considered a separate need.
** EXCEPTION ** If a multi-child pregnancy is the result of the use of fertility drugs, in vitro fertilization, or other artificial means, all pregnancy and birth-related complications of the children will be treated as one need.
Genetic Disorders (and Hereditary Diseases) are shareable when at least ONE of these FOUR is true:
- Neither the condition nor a symptom of the condition was discovered until after membership had begun
- The condition has not required treatment or produced harmful symptoms, and has not deteriorated for at least five years
- The condition exists in a person who has been included in a membership from birth, and the mother was included in a membership prior to the pregnancy
- If the condition exists in a person who was adopted, the person has been included in a membership since the adoption, and the adopting parents were unaware of the condition at the time the adoption was finalized.
Is fertility treatment or testing shareable? Any special considerations?
- Fertility treatment or testing is not shareable
- However, medical expenses for an embryo adoption and implantation by a married couple will be eligible for sharing as a Special Prayer Need
Are procedures for sterilization shareable?
Procedures for sterilization, and not primarily to treat a medical condition, are not shareable.
Elective sterilization such as tubal ligation and vasectomy, or the reversal of the same, is not shareable. But, reversals may be shareable as Special Prayer Needs
What about surrogacy? Shareable or not?
Expenses related to a surrogate pregnancy, whether or not the surrogate is a member, are not shareable.
Do the Guidelines allow for ANY maternity sharing for a woman who is on a one-person membership?
Yes, through Special Prayer Needs.
Maternity needs for one-person memberships of women under age 45 when they become pregnant, for both Samaritan Basic and Samaritan Classic, are not eligible for sharing except as Special Prayer Needs. This includes post-birth needs of the mother related to complications of birth.
Ectopic Pregnancies - what expenses are shared?
Procedures related to a ruptured fallopian tube (including post-operative recovery of the mother, follow-up care, and treatment of any complications), and, where an ectopic pregnancy is diagnosed before a rupture, all pre-operative tests and consultations, and expenses related to keeping the mother under medical care while determining what care should be offered for the mother and child.
Ectopic Pregnancies - what expenses are NOT shared?
Procedures directly related to the termination of a living, unborn child and/or removal of the living, unborn child from the mother due to an ectopic pregnancy are not shared (e.g. methotrexate, salpingectomy, salpingostomy), unless the removal of the child from its ectopic location was for the primary purpose of saving the life of the child or improving the health of the child.
