*Official Member Guideline

General

As with any other sharing request, expectant mothers pay a single IUA for all expenses related to their eligible maternity sharing request. Expenses eligible for sharing 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 initial date of service. 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 (6) months of service. Bills submitted more than six (6) 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 ineligible for sharing. 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.

Eligible for Sharing 

Prenatal

• Routine office visits
• Routine lab work
• Immunizations must be ordered by a licensed practitioner and is subject to the CDC Pricing List: 
  • RSV: One does ordered as part of routine prenatal care for women in their third trimester during the months of September through January. 
  • Tdap: Ordered for women between 27 and 36 weeks, only.
• 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
• Nitrous Oxide: Must use FDA approved devices, cannot be combined with or also receive an epidural, and a sharing limit of $400.
• Legally practicing midwives - In order for midwifery costs to be eligible for sharing, an itemized breakdown of the services provided in their global package must be provided to Zion HealthShare before services are rendered. 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 is only eligible for sharing shareable if there is a 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 first. Exceptions will be considered for multiple births. Pelvic manipulation will no longer be shareable with the eligible maternity request after the date of delivery.
• 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 eligible for sharing 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 (6)-week postpartum checkup with pap test
• Two-week cesarean post-op appointment

Ineligible for Sharing

Prenatal

• 3D and 4D ultrasounds
• Most immunizations (such as flu shots)
• Non-prescription supplements
  • Chiropractic services for babies in breech positions
• Genetic testing/counseling, including but not limited to:

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 the Maternity department 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 will require a separate sharing request. All of the baby’s checkups and any complications are subject to eligibility determination based on the Member 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 eligible 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 eligible 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 eligible maternity sharing request.

Premature Birth

A newborn’s eligible medical needs are considered eligible for sharing 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 eligible for sharing 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 ineligible for sharing.