View Zion HealthShare’s Maternity Guide to learn more.

General

As with any other sharing request, expectant mothers pay a single IUA for all expenses related to their maternity sharing request. Shareable expenses may be related to miscarriage, prenatal care, postnatal care, and delivery.

The maternity sharing request must be submitted no later than six (6) months from the date of pregnancy confirmation. Sharing requests submitted after that date will be considered ineligible for sharing.

Once the maternity sharing request is open, submittal of original, itemized bills for the medical expense(s) must be within six months of service. Bills submitted more than six months after the date of service may be considered ineligible for sharing.

Waiting Period

Conception occurring prior to membership start date is ineligible for sharing. Pregnancy existing prior to membership is not shareable. The conception date will be confirmed by medical records. Members who purposely misrepresent their conception dates may be subject to membership revocation.

Newborns who are not born in connection with an eligible maternity sharing request may be added to a household membership by calling or emailing Zion HealthShare. The newborn’s membership start date can be no sooner than seven (7) days after delivery, if not born in connection with an eligible maternity sharing request. Any complications that the newborn may have, or any medical conditions present at birth, will be considered pre-membership medical conditions.

See the Pre-membership Medical Condition section for details.

What is Shareable

PRENATAL

• Routine office visits
• Routine lab work
• Fetal non-stress test (after 36 weeks)
• Up to three standard ultrasounds (unless an unexpected complication requires additional scans)
• STD/STI screenings prescribed by a licensed practitioner as part of routine prenatal care

DELIVERY

• Ob-gyn labor and delivery
• Cesarean
• Multiple births
• Hospital labor and delivery
• Hospital room and board
• Anesthesiologist
• Legally practicing midwives - In order for midwifery costs to be shareable, an itemized breakdown of the services provided in their global package must be provided to Zion HealthShare before services are Not all midwifery services may be eligible for sharing.
• Home births
• Maternal fetal medical specialist consultations, when ordered by the medical provider managing the pregnancy.
• Pelvic manipulation – only shareable if new onset of back and/or pelvic pain, after the 30th week, and with a total of 20 visits but no more than $2000, whichever occurs Exceptions will be considered for multiple births.
• Birthing centers
• Charges related to unexpected complications for the mother
• One in-hospital pediatrician visit, including routine immunizations, routine lab work, and routine hearing tests (all shareable when the baby is added to the membership within 30 days of delivery and when these services occur prior to discharge from hospital)

POSTNATAL

• Mother’s six-week postpartum checkup with pap test
• Two-week cesarean post-op appointment

What is Unshareable

PRENATAL

• 3D and 4D ultrasounds
• Most immunizations (such as flu shots)
• Non-prescription supplements
• Genetic testing/counseling, including but not limited to:
  • Amniocentesis
  • Inhibin A
  • Alpha-Fetoprotein Serum (AFP)
  • Any type of Nuchal Translucency (NT) ultrasound
  • NIPT testing
  • Services by companies providing genetic testing
  • Chiropractic services for babies in breech positions

DELIVERY

• Doula services
• Birthing tubs (or other items related to midwife delivery)
• Placenta encapsulations
• Circumcision
• Diagnostic hearing screening (including evoked auditory tests, BAEP, ABR, or BAER)

POSTNATAL

• Breast pumps
• Lactation consultant
• Mother’s immunizations
• Postpartum counseling
• Additional postpartum services

Other services may be ineligible or eligible as determined by Zion HealthShare. If you have questions about a specific service, please contact Zion HealthShare prior to receiving care. All genetic testing will be the responsibility of the member.

Checkups for the baby after delivery are not part of the maternity sharing request. If the newborn has any complications, they would require a separate sharing request. All of the baby’s checkups and any complications are subject to eligibility determination based on the Member Guidelines.

Maternity IUA Payment

Please reference the Submission of Sharing Request guidelines.

Home Births

Home births typically incur fewer expenses. If the costs are significantly lower for a home birth than for a hospital birth and the member is under the care of a licensed care provider, Zion HealthShare may partially waive the IUA for a maternity sharing request.

Separate Sharing Requests

Any complication for the newborn occurring after birth, whether the complication existed before or after birth (including congenital conditions), is separate from the mother’s maternity sharing request and will require its own sharing request and IUA (in the event of a multiple birth, complications, each individual newborn will require their own sharing request and IUA).

Expenses for any pregnancy or birth-related complications of the mother are eligible for sharing as part of the maternity sharing request.

Premature Birth

A newborn’s eligible medical needs are considered shareable as part of an eligible maternity sharing request, even if the baby is born prematurely. Any services outside standard maternity and newborn care would be considered a separate medical need for the baby and will require a new sharing request submission and new IUA.

In Vitro Fertilization (IVF)

Expenses related to fertility treatments are ineligible for sharing. For pregnancies occurring by IVF or other non-traditional fertilization methods, Zion HealthShare defines date of conception as the date the fertilized embryo is implanted in the uterus.

Miscarriage

Any expenses related to a miscarriage that is associated with an eligible maternity sharing request are shareable if the costs exceed your IUA.

Expenses related to a miscarriage that is not associated with an eligible maternity sharing request are eligible under a regular sharing request.

Gestational Diabetes

Gestational diabetes is considered a complication of pregnancy, and members who develop this condition are encouraged to follow the recommendations of their treating providers.

Gestational diabetes is not considered insulin dependent. Therefore, costs of medications prescribed to treat gestational diabetes, including insulin, can be shared according to our prescription sharing guidelines.

Members are encouraged to seek counsel from their ob-gyn on dietary changes and exercise. Glucometers and test strips can be purchased at local pharmacies or online at reasonable costs. For these reasons, nutritionists, other therapists, and testing supplies are not shareable.