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Guidelines Christian Health Care Newsletter Section IX
1. Publishable maternity needs include bills for prenatal care, delivery, post-natal care, miscarriage and congenital conditions (any condition present at birth except for genetic defects and hereditary diseases).. 2. Genetic defects and hereditary diseases for the baby are only publishable as provided in Section VIII:A:8. (But see paragraph 5 below) 3. Bills for birth-related complications and non-genetic congenital conditions that develop in newborn babies up to six-months old are publishable as a maternity need, and therefore are a regular need. (But see paragraph 5 below) 4. Bills for complications to the mother may be published as a separate need according to the regular publishable need Guidelines (Sections VI and VII) (But see paragraph 5 below) 5. If a mother was pregnant before becoming a member, any complications she or the baby develops from conception through the birth will be considered a condition that was evident prior to membership and the bills will not be publishable (except a genetic defect/hereditary disease may still be published if the requirements of VIII:A:8 have been met.) 6. Medical expenses of the birth mother and an adopted child, for which the adopting parents are liable, are publishable as a maternity need to the same extent as if the child was a natural child less any credit amount which the member is entitled to under the federal adoption income tax credit due solely to those medical expenses. B. Initial Unpublished Amount 1. Members are responsible to pay the first $300 dollars of each of their own maternity needs. 2. The initial unpublishable $300 is waived for homebirths because they tend to reduce overall maternity costs. Publishable bills for homebirths include services of midwives, doctors, and/or nurse practitioners. 3. The initial unpublishable $300 is waived for a vaginal birth after caesarean (VBAC). C. Maternity Publishable Amount Limits for First 18 Months of Membership 1. General Rule—The amount that a member is eligible to have published for maternity needs from any single pregnancy will be no less than the total amount the member has sent in monthly shares since the beginning of the membership. (Shares sent in prior to the marriage by both spouses will be similarly counted, as long as there has been no interruption in membership.)The amount eligible for maternity needs from a subsequent pregnancy as a member is not reduced by any amounts that were published for prior pregnancies. If a member terminates the membership or allows it to lapse for any reason, and later rejoins, the amount available for maternity needs will be calculated from the date of the most recent start of membership.This publishable limit calculation applies even though the wife was not a member when she conceived. However, any maternity expenses that were incurred while she was not a member would not be publishable. 2. Effect of Household Change—If the household size of the membership changes during a pregnancy effecting the share amount, the amount available for maternity Needs will be calculated using the old share amount up to the time that the change occurs. 3. Effect of Parent’s Membership—If a child of a member has become a member without interruption from his parents’ membership, he will be allowed $50 multiplied by the number of months he was under his family’s membership, in addition to the calculation for his or her own membership, as long as there was also never a subsequent interruption in membership. If both spouses have uninterrupted memberships under their parents, the allowance shall include both calculations. 4. Casarean and Premature Births—The publishable amount limit is doubled for: (a) Cesarean births (unless the pregnancy began before the membership began.) (b) A baby born prematurely requiring extraordinary care. 5. Multiple Births—When two or more babies are born, the normal publishable amount limit will be multiplied by the number of babies to determine the total amount available for publication, unless the mother was pregnant when the membership began. 6. Combinations of Cesarean, Premature, and Multiple Births—Each special condition will result in an additional multiplication of the publishable amount. For example, if the amount the member has sent in past shares, plus any credit for the parent’s membership, equals $1,500.00, then the premature birth of triplets by Cesarean would be publishable up to: General Rule $1,500 Triplets $3,000 Cesarean $1,500 Premature $1,500 Total publishable $7,500 7. Early Publication—If a maternity care provider will reduce the amount of normal charges if a member pre-pays some or all of the bill, we will consider publishing the maternity need prior to the birth. The member must request an estimate and submit it with the Need Processing Form. If the resulting bills are less than the pre-paid amount, the member must contact a Member Services specialist who will advise where to send the surplus. 8. Special Prayer Need Eligibility—When the amount that a member is eligible to have published as a maternity need is not enough for all the bills, the remaining balance may be considered for publication as a Special Prayer Need. D. Calculation of 18 Months of Membership for Maternity Needs 1. General Rule—Each month of continuous membership of the husband or wife prior to incurring a maternity need counts toward the 18 months as long as the wife was included in the membership prior to conceiving. If the husband is a member and later the wife joins, the husband must continue as a member, if living, for time of membership to counts toward the 18 months. Example: If the husband has been a member for 9 months, then the wife joins and one month later conceives, in 8 more months they will have the 18 months credit as long as the husband remains a member. Maternity expenses incurred during the first 8 months of the pregnancy will be published under the limits of Section C, and expenses incurred after the 18th month (even if for the same pregnancy) will be published under the normal $100,000 limit, less any expenses already published. The 18 month period must be consecutive months—any break in the membership will require starting again to reach the 18 months. 2. Membership Prior to Marriage—All consecutive membership time of both spouses prior to marriage will count towards the 18 months as long as they both remain members. Example: If the couple above are both members for 3 months prior to their marriage, and the husband remains a member, but the wife drops her membership when they get married, the husband's 3 prior months are added to the 9 months after marriage so that when the wife conceives one month later, they need only 5 more months to reach the 18 month credit. If the wife had remained a member throughout the marriage, the 18 months would have been reached after 12 months of marriage (Husband's 3 prior and wife's 3 prior + 12 months of membership in marriage) 3. Effect of Being Within Parents' Membership—As long as there is no break in membership, both spouses consecutive time in their parents' memberships will also be counted toward the 18 months. Example: If the couple above had both been under their parents' memberships for 9 months prior to being married, and the wife did not join at marriage, her past membership is no longer counted, and they will not have the 18 months credit until 9 months later. The wife would still have to join before conceiving to receive the 18 months credits that accrued to her husband. If they had both joined at marriage, they would have been credited for 18 months immediately. |
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