- What’s eligible under the maternity program?
CHM shares eligible medical bills for prenatal care, delivery (including cesarean and multiple births), home births, midwives, postnatal care, and complications that arise for mother and baby.
Important note: For a pregnancy to be eligible for sharing, the mother must have joined the Gold program at least 300 days before their doctor’s estimate of due date
For prenatal care, CHM shares:
- routine office visits
- lab tests
- maternity-related prescriptions and immunizations
- three ultrasounds
For delivery, CHM shares the costs associated with:
- facility labor and delivery
- physician labor and delivery
- anesthesiology services
- complications that arise for the mother and baby
Note: CHM shares expenses from either a midwife or a physician, not both. (For an exception, see CHM’s maternity Guidelines.) We cannot share expenses from more than one midwife.
For postnatal care, CHM shares:
- mother’s postpartum check-ups
- lactation consultations
- wellness visits for the baby up to 90 days after delivery
- circumcision for baby up to 90 days after delivery
- tongue tie for the baby up to 90 days after delivery
For a list of ineligible maternity expenses, please refer to CHM’s maternity Guidelines.
- I found out I’m pregnant—what do I do?
Congratulations! If you haven’t already, call 1-800-791-6225 to speak with our Maternity Support Team within the first 16 weeks of your pregnancy, and we will help you connect with quality maternity providers in your area as well as give you a $500 reduction on your maternity Personal Responsibility.
Once you’ve selected a provider, request a prepayment agreement/global fee. If you’re unsure what to ask for, we’ve prepared a card detailing the information we need that you can hand directly to your provider. Note: If you can’t get a prepayment agreement with all the necessary information from your provider, call our Maternity Support Team for assistance at 1-800-791-6225.
After receiving your prepayment agreement/global fee, log into your Member Portal to fill out our online forms and upload your medical document(s).
- What’s a prepayment agreement/global fee?
Your physician or midwife may provide you with a prepayment agreement also known as a “global fee.” The prepayment agreement usually includes:
- prenatal appointments
- physician/midwife delivery charges
- postpartum appointments (for mom)
In order to process your prepayment agreement, it must include:
- provider information
- patient name
- a list of all services included in the fee
- total fee for services
- the payment due date or payment plan details
You will need to obtain itemized bills for any medical services performed outside of the global fee. Charges outside of the global fee typically include:
- lab work
- additional appointments
- hospital/ER visits
Note: Some prepayment agreements/global fees include lab work and ultrasounds. Please review your agreement before sending in itemized bills.
- Does CHM share for midwives and/or birthing centers?
CHM will share costs for legally practicing midwives and birthing centers.
If you aren’t birthing at a hospital, you’ll need to submit a prepayment agreement from the provider overseeing your care. This prepayment agreement should include prenatal care, delivery of the baby, and postpartum and postnatal expenses following the birth. If there are any additional charges not included in the prepayment agreement, you’ll submit these to CHM as “maternity add-on” bills.
Once you receive the prepayment agreement, immediately upload it to the Member Portal.
Important note: CHM shares for either a midwife or a physician,
- Does CHM reimburse facility/hospital prepayment agreements?
Our Maternity Support Team (MST) wants to help our members receive bundled facility flat rates. Please contact the MST at 1-800-791-6225 for assistance finding flat rates available in your area.
Facility/hospital prepayment agreements (or flat rates) must include:
- the patient’s name
- provider or place of service
- CPT codes or descriptions of services
- the total charge for each service
- length of your hospital stay
- whether newborn charges are included
- due date of the prepayment agreement
Anesthesiology charges are eligible for sharing, but CHM cannot share these expenses prior to the birth. You’ll need to pay these charges out of pocket if your provider requires payment before delivery. You can upload the estimated bill into the CHM Member Portal prior to delivery, then submit the actual bill after the birth. Following this suggestion will significantly shorten sharing time.
Note: You may receive additional medical bills for your baby’s after-delivery hospital care, such as lab work, hearing tests, pediatrician visits, etc. You can submit the itemized bills as “maternity add-on” bills.
- What’s the difference between a prepayment agreement and an estimate?
An estimate is a ballpark figure that's subject to change. A prepayment agreement is an agreed-upon price that stays the same as long as the conditions of the agreement are met.
While prepayment agreements are preferable, if you receive an estimate, please submit it so our team can work with you and your provider to receive additional information.
If you need assistance obtaining a prepayment agreement, please contact the Maternity Support Team at 1-800-791-6225.