Inpatient Hospital and Related Services
The Expatriate Medical Plan covers medically necessary inpatient hospital admissions for an unlimited number of days. Covered services include, but are not limited to the following services and is subject to change at any time, also subject to any limitations or requirements of the Plan and based on medical necessity:
- Allergy testing and treatment, when provided as part of inpatient care for another covered condition;
- Anesthetics and their administration;
- Bariatric surgery subject to claims administrator guidelines;
- Basic metabolic examinations;
- Cosmetic surgery when needed to:
- Reconstruct or treat a functional defect of a congenital disorder or malfunction;
- Treat an infection or disease;
- Treat an injury or accident; or
- Reconstruct a breast after mastectomy. Coverage for the following services is available in a manner determined in consultation with you and your physician:
- Diagnostic services, including:
- EEG, EKG, and other diagnostic medical procedures;
- Laboratory and pathology tests; and
- Radiology services.
- Electrocardiographic and physiotherapeutic equipment usage;
- Hemodialysis for kidney failure;
- Intensive care unit service;
- Maternity care, including:
- Any required care for an illness or injury that the newborn develops either before or after birth as long as you and your newborn are enrolled in the appropriate coverage category within prescribed enrollment time frames;
- Care required due to miscarriage or ectopic pregnancy;
- Coverage of eligible expenses if your covered child has a baby, but not including nursery or other expenses incurred by the newborn child;
- Delivery by a certified, registered nurse or midwife in a birthing center;
- Drugs, medications, and anesthesia;
- Normal or cesarean section delivery;
You must enroll a new dependent within 31 days of birth in order for coverage to be effective retroactive to the date of birth. Please see "Eligible Dependents" and "Changing Your Coverage Midyear" for more information.
- Routine medical and hospital nursery care for your covered newborn child, as long as you and your newborn are enrolled in the appropriate coverage category within prescribed time frames;
- Circumcision by a licensed provider (for your covered newborn child), as long as you and your newborn are enrolled in the appropriate coverage category within prescribed enrollment time frames; and
- A semi-private room. The period of hospitalization for childbirth (for either the mother or the covered newborn child) is up to 48 hours following a vaginal delivery or 96 hours following a cesarean section. (However, your attending physician — after consulting with the mother — may decide to discharge the mother or newborn child earlier.)
- Mental health care/substance abuse care;
- Operative and surgical procedures by a licensed provider for the treatment of a disease or injury, including pre-operative preparation and post-operative care;
- Organ and tissue transplants including replacing a non-functioning or damaged organ or tissue with a working organ or tissue from another person. Covered services include physician and hospital costs, donor search, test to establish donor suitability, organ harvesting and procurement, and anti-rejection drugs. Donor expenses related to the transplant procedure are covered if the transplant recipient is a covered member under the Expatriate Medical Plan, but only to the extent that the donor expenses are not covered under another health insurance plan.
- Pre-admission testing when completed within seven days of hospital admission;
- Semi-private room and board; and
- Take-home drugs and medications.
This list is subject to change at any time.
The Expatriate Medical Plan limits the benefits you are eligible to receive if you have more than one surgical procedure performed at the same time. When you have multiple procedures performed at the same time, the Expatriate Medical Plan will pay:
- 100% of the coinsurance percentage amount for the primary or major surgical procedure;
- 50% of the coinsurance percentage amount for the secondary procedure; and
- If more than two procedures are performed, please check with Cigna Global Health Benefits for coverage details.
- Please see contact information for Cigna Global Health Benefits at the beginning of this Expatriate Medical and Dental Plans section.
In accordance with the Newborns' and Mothers' Health Protection Act, group medical plans and health insurance issuers may not, under federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother to less than 48 hours after a normal vaginal delivery, or to less than 96 hours after a cesarean section. Further, the Plan cannot require that any medical provider obtain authorization from the Plan or any insurance issuer for prescribing a length of stay not in excess of the above periods.
Solely to the extent required under the Women's Health and Cancer Rights Act (hereinafter "WHCRA"), the Plan will provide certain benefits related to benefits received in connection with a mastectomy. The Plan will include coverage for reconstructive surgery after a mastectomy.
If you or your dependent(s) (including your spouse/domestic partner) are receiving benefits under the Plan in connection with a mastectomy and you or your dependent(s) (including your spouse) elect breast reconstruction, the coverage will be provided in a manner determined in consultation with the attending physician and you or your covered dependent(s) (including your spouse/domestic partner) for: