Nova Pathfinder Healthcare covers most Women’s Health Services, including birth control, prenatal, newborn, and postpartum care. Well-visits, licensed birthing centers, and delivery are all a part of your healthcare plan. You get to decide the path you choose on your journey to parenthood. Nova does require Pre-Authorization and planning to facilitate the birthing process, so you will need to work with one of our Care Advocates to tailor a personalized pregnancy protocol for you and your newborns’ care.
Please Note: All copayment and coinsurance costs associated with the services below are before your deductible has been met if a deductible applies. This means that you must pay all of the costs from providers up to the deductible amount before this plan begins to pay for the following items.
Members pay0% coinsurance or $0 copay after the deductible has been met.
All conventional methods of birth control outlined in the Affordable Care Act (ACA), including all Food and Drug Administration (FDA)-approved contraceptive methods prescribed by a woman’s healthcare provider, including:
- Intrauterine devices (IUDs), including insertion and/or Removal.
- Barrier Methods including female condoms and sponges
- Implantable contraceptives.
- Injectable contraceptives when administered by a Physician.
- Voluntary sterilization (tubal ligation)
- Diaphragm fitting procedure.
See reimbursement policy on our website for submitting receipts for Birth Control.
Prenatal and Newborn Care Benefits
Pregnancy and Delivery Facilities
Nova Pathfinder Limited Healthcare allows for coverage based on our pregnancy protocol for delivery, pre-and post-maternity services & facilities that provide the lowest risk to the expectant mother and the baby in the listed choices. This includes a certified hospital or birthing center, OBGYN/hospital delivery, and c-section.
Prenatal Office Visits
You may have to pay for services that aren’t preventive or part of your delivery if you have not met your deductible and/or if the services fall outside of your pregnancy protocol. Some services, such as Wellness visits, are covered before your deductible is met. If you have already met your deductible, there is no copay or coinsurance. However, you should ask your provider if the services needed are preventive or part of your delivery. Then check what your plan will pay for using the pregnancy protocol as a guideline. Please call us about combining primary care annual wellness visit types because your OBGYN could be an annual wellness visit or a pediatric annual wellness visit and a pediatric vision/hearing annual wellness visit.
Benefits provided for Pre-Natal Services include:
- Prenatal care
- Prenatal diagnosis of genetic disorders of the fetus by means of diagnostic procedures in case of high-risk pregnancy
- Outpatient Maternity Services
- Involuntary complications of pregnancy,
- Inpatient Hospital maternity care including labor, delivery, and post-delivery care
Involuntary complications of pregnancy include:
- Puerperal infection
- Cesarean section delivery
- Ectopic pregnancy
Diagnostic Prenatal Testing Includes:
Standard Prenatal testing for the diagnosis of genetic disorders of the fetus in case of high-risk pregnancy is covered. See below for other standard diagnostic testing information.
- Standard Diagnostic Tests: If you are unsure if the test or screening will be covered, please get a preauthorization. If your provider orders an EKG or other needed x-rays (i.e., chest x-ray), these are covered as part of your annual wellness visit. For more complex tests over $75.00, it is a good idea to request a preauthorization to know your cost.
- Annual Wellness Visit Laboratory Tests: (This list contains examples of standard annual wellness Visit lab tests that may be ordered) Complete Blood Count (CBC), lipid, Comprehensive Metabolic Panel (CMP), Cholesterol Panel, Urinalysis, Glucose Blood Sugar, Hemoglobin A1c, Prothrombin time with INR, C-Reactive Protein (CRP) (HS-CRP), and Thyroid Function. There are other lab tests we will cover. If you are unsure if we would cover a lab test as part of an annual wellness visit, please ask us.
- Lab tests are covered up to $50.00 for each test. Testing facilities are paid directly, not applied to the deductible, starting after three. For any laboratory tests that are over $50.00
Pre-planned C Section births require a preauthorization, a provider’s order, and planning with our Care Advocates as a part of your Pregnancy Protocol Plan. All preadmission testing for planned C Sections must be performed and included in the surgical procedure when possible. All surgeries must meet the definition of medically necessary based on our guidelines. All Professional, Facility, and Other Charges that will be billed as part of the surgery should be included in the preauthorization.
Note: Emergency C Sections do not require preauthorization and fall under standard emergency surgery protocols.
The Newborns’ and Mothers’ Health Protection Act requires group health plans to provide a minimum Hospital stay for the mother and newborn child of 48 hours after a standard vaginal delivery and 96 hours after a C-section unless the attending Physician, in consultation with the mother, determines a shorter Hospital length of stay is adequate. If the hospital stay is less than 48 hours after a standard vaginal delivery or less than 96 hours after a C-section, a follow-up visit for the mother and newborn within 48 hours of discharge is covered when prescribed by the treating Physician. This visit shall be provided by a licensed health care provider whose scope of practice includes postpartum and newborn care. In consultation with the mother, the treating physician shall determine whether this visit shall occur at home, the contracted facility, or the Physician’s office.
Newborns must be added to the plan within 30 days after birth under the family plan. The newborn’s immediate medically necessary needs will be covered within the 30-day grace period under the mother’s plan up to the limits. If a member is on an individual +1 plan, they must upgrade to a family plan. Children will then be covered under standard coverage as a member.
For Outpatient routine newborn circumcisions, routine newborn circumcisions are circumcisions performed within 18 months of birth for this benefit.
All DME require a preauthorization and a provider’s order. See the preauthorization form for details on how to submit a complete request for preauthorization for a Breast Pump.
All DME must meet the definition of medically necessary based on Medicare and our guidelines.
Breastfeeding and Breast Pumps DME (Durable Medical Equipment) Breast Pumps fall under DME (Durable Medical Equipment) and are limited to a maximum of $500.00 each calendar year.
Excluded Services & Other Covered Services
- Infertility services
- Cosmetic surgery
Other Covered Services (Limitations may apply to these services)
Abortion services are covered only in medically necessary lifesaving situations.