Brigham Young University - Idaho

Co. DMBA

Physician's Services

Obstetrical (maternity) care under the Student Health Plan is provided by Deseret Mutual (DMBA) contract providers in the community. These physicians provide the care at rates which result in significant savings to you as a policy holder. You may find a contracted provider by visiting https://www.dmba.com/sc/medical/FindProvider.aspx. Before your first visit, you must call DMBA at 1-800-777-3622 to pre-authorize your visits to the OB/GYN.

DMBA needs to know:

• Which physician you are going to see
• The date of your first appointment
• Your due date

Plan Benefits for Obstetrical Care

Proper prenatal care is extremely important for your health and the health of your baby. Your co-payment will not vary with the number of office visits you have. Therefore, please be sure to seek early and continued pre-natal care from the contract provider you choose.

Additional Care

If authorized, the contracted rate covers basic prenatal care, delivery, and your six week checkup after delivery. Additional care or tests, such as an ultrasound, sonogram, or non-stress test, will be billed separately and regular. Plan benefits will apply (80 percent coverage). Be sure to call DMBA (1-800-777-3622) to obtain authorization.

If you have obtained authorization for your obstetrical care through DMBA no authorization is needed for the first ultrasound. Any additional care or testing requires a separate authorization.

Hospital

Deseret Mutual has contracted with Madison Memorial Hospital in Rexburg to provide hospitalization for delivery.

After you have paid your co-payment, the benefits for the remainder of eligible expenses are in the chart to the right.

If either mother or baby must remain in the hospital for more then two days for a normal delivery, or four days for a C-section, call DMBA (1-800-777-3622) immediately to pre-authorize extended stay.

Plan Benefits for Hospital Care

Mother co-payment for a student	Newborn Child co-payment for a student
$300	$750

Anesthesiologist and Pediatrician

You will be billed separately by the anesthesiologist for the care provided at the time of delivery and by the pediatrician who sees your baby in the hospital. Regular Plan benefit percentages will apply to these bills.

If a circumcision is done you will pay a $25 copayment plus 20 percent. Payment will be based on the maximum allowable charge for these services as determined by DMBA.

Be sure to add your baby to your insurance policy within 60 days so the pediatrician's bill can be covered. Once your baby is released from the hospital, medical care will be provided at the Student Health Center or by a contracted pediatrician. Well-baby care does not require preauthorization.

Care Outside the Rexburg Area

Contracted physicians in Rexburg provide care at rates that result in significant savings to you as a Plan participant. If you are away from the Rexburg area and enrolled on the Student Health Plan you may obtain care from any qualified, appropriately licensed medical practitioner. However, it is to your advantage to make sure the physician and hospital providing your care are part of Deseret Mutual's Preferred Provider Network. If they are part of DMBA's Preferred Provider Network the health plan will pay 80 percent of the allowable charges after you pay your co-payment. If they are not a Preferred Provider you will be responsible for 50 percent instead of the 20 percent. This network extends throughout most areas of the United States and consists of physicians and hospitals who provide quality care at substantially discounted rates. To find out who the contracted providers are in Hawaii, call 1-808-293-3970; Idaho and Utah, call 1-800-777-3622 (www.dmba.com), and all other states, call First Health Medical Network at 1-800-237-5702 (www.firsthealth.com). Contact DMBA regarding how the health plan will pay for services outside the Rexburg area and to obtain preauthorization for those services.

Important Things to Remember

At your first visit, your obstetrician will want to do prenatal blood work. You may have it done there and the health plan will pay 80 percent of the cost, or you may get an order from your doctor and bring it to the lab at the SHC. Your co-payment will be 20 percent (the SHC lab charges are usually cheaper). This same procedure would apply to all lab work your obstetrician might order, with the exception of the routine HCT and urine test done in the doctor's office. There will be no additional charge for these tests.

Pap tests are not covered under the health plan when they are performed outside of the Student Health Center.

Call DMBA (1-800-777-3622) to obtain authorization before having a second ultrasound, an NST, or an amniocentesis.

Your newborn baby is a new, separate participant under the Plan. Therefore, the health plan can cover their percentage of the baby's hospital and pediatrician bills only if the baby is added to your coverage as a dependent for the enrollment period in which he or she is born.

You have 60 days after the date of birth to add your baby to your policy. If the addition of this new dependent changes your premium level, the additional premium must be paid for the enrollment period in which the baby was born in order for bills incurred during the period to be covered.

To add the baby to your policy, you will need to provide the Student Health Center (208-496-3407) with the baby's name and date of birth, sign an enrollment form, and pay any additional premium due. Be sure to do this WITHIN 60 DAYS of the baby's birth.

Maternity For Non-Student Spouse

Benefits are available after a total of $5,500 has been paid.

This is a $750 deductible ($750 per person up to $1,500 per family).

$4,750 is the nonstudent spouse's financial responsibility before benefits apply.

The break down of the $4,750 is as follows:

Physician/Nurse-Midwife Services

You pay a $1,900 deductible and co-payment for the mother's physician bill for prenatal care and delivery. This includes the $250 maximum physician copayment.

After you have paid your deductible and co-payment, the benefits of eligible expense are:

Contracted Provider: The plan pays 80 percent Non-Contracted Provider: The plan pays 50 percent

Hospital Services

You pay a $2,850 deductible and co-payment for the mother's hospital bill. This includes the $300 hospital co-payment for the mother.

You pay a $750 deductible and $300 co-payment for the hospital bill, if they are enrolled in the student health plan.

After you have paid your deductible and co-payment, the benefits of eligible expense are:

Contracted Provider: The plan pays 80 percent

Non-Contracted Provider: The plan pays 50 percent

Circumcision

If the baby's $750 deductible has been met, then there is a $25 co-pay and then the plan pays 80 percent.