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20/01/2021

Maternity Rules

 

 

 

For Members

 

 

What is Maternity?

  • Maternity is the provision of care during pregnancy and immediately before/after childbirth.
  • Pregnancy is the term used for the period in which a fetus (baby) develops inside a woman’s uterus.
  • In general, there are limits on number of ultrasounds, visits to your Gynecologist and amount utilization limit during pregnancy every policy. Please always check policy always. Exceptions on limits can be made for high risk (score above 10) or low risk (score below 10) pregnancies (Check Table: 1).
  • The Risk factors are monitored throughout pregnancy.
  • When a maternity claim is submitted, marital status will always be confirmed, including the pregnancy test.
  • Generally, declaration of pregnancy should be done at the time of start of the policy. Some policies have a waiting period for maternity benefits, which means that claims will only be accepted after the waiting period.
  • Declaration of date of Last Menstrual Period (LMP) is mandatory.
  • The maternity benefits might vary among policies from Dubai, Abu Dhabi and Northern Emirates.

 

Table 1: Complication Arising / Developing During Current Pregnancy
Complication Arising / Developing During Current Pregnancy Risk Score
Unclear Expected Date of Delivery (EDD) 4
Blood group antibodies 10
Positive HEP B C/HIV 10
Distorted Serum HCG/ AFP /UE3 10
Hypertension 10
Proteinuria without Urinary Tract Infection (UTI) or hypertension 10
Anemia (9 or below) 8
Low platelet count < 120 X 109 8
Abnormal Glucose Tolerance Test (GTT) 10
Pre term spontaneous ruptured membranes 10
Small for dates / Large for dates 10
Confirmed chickenpox/rubella/parvo infection 10
Polyhydramnios 10
Oligohydramnios 10
Mal-presentation after 36 weeks 10
Obstetric cholestasis 10
Threatened pre-term labor 8
Intrauterine fetal death 4

 

 

 

Dubai (DHA) Policy:

 

  • Low risk care:
    • Booking Risk Assessment tool (as below) is used to assign a scoring. If identified as low risk, by scoring 9 or less on the, all antenatal care will continue with the Obstetrician or trained GP.
    • Number of antenatal appointments for low risk women:
      • 8 Consultations.
      • 3 ultrasound.
      • 1 anomaly scan.

 

  • High Risk Care:
    • If identified as high risk, by scoring of 10 or more on the Booking Risk Assessment Tool/Continuing Risk Assessment Tool, the member should be referred to hospital for assessment and follow-up by a specialist obstetrician (check Table:2).
    • In case of High Risk pregnancy, your treating physician will decide upon the number of visits and ultrasounds.
  • Neonatal circumcision: Check your policy.
  • NIPT test is not covered for DHA policies.

 

TABLE 2: RISK BOOKING CRITERIA
1.    CURRENT PREGNANCY
Criteria Score
Under 15 years 10
Over 40 years at delivery 8
Misuse of illicit substances/alcohol 10
Smoking 4
Body Mass Index (BMI) 40 or over, OR less than 18 10
Haemoglobinopathy / severe anemia 10
Blood pressure of more than 140/90 at booking 10
Multiple pregnancy (e.g. Twins) 10
History of infertility: conception -spontaneous, Clomid, IVF, Gift, ICSI. 10
Women who request diagnostic testing (i.e. family history of genetic disorder) e.g. amniocentesis, CVS. 10
2.    MEDICAL HISTORY
Criteria Score
Cardiac Disease 10
Diabetes (existing) 10
Gestational Diabetes during any pregnancy 4
Endocrine (hormonal) problems e.g. Thyroid disease 8
Severe gastrointestinal disease e.g. ulcerative colitis 10
Serious Psychiatric illness (excluding women on SSRI drugs e.g. Prozac and previous postnatal depression) 10
Asthma, taking oral steroids 10
Major kidney disorder / liver disease 10
Detached Retina 10
Fractured Pelvis (be aware for delivery) 4
Autoimmune disease 10
Uterine abnormality / fibroids / pelvic mass / IUCD in situ 10
3.    PREVIOUS PREGNANCIES/LABORS /BIRTHS
Criteria Score
3 or more proven miscarriages/ + mid-trimester 10
Para 7 or more 10
Previous last baby at term of less than 2.5kgs, IUGR, IUD, NND, SB, cerebral palsy 10
Eclampsia or HELLP syndrome, PIH 5
Admission to ITU or HDU (pregnancy related) 5
Rhesus/ABO antibodies 10
Fetal loss after 22 weeks 10
Placental abruption 10
Preterm labor in last pregnancy before 35weeks 10
Previous obstetric cholestasis 10
HIV positive / Syphilis positive 10
Essential hypertension 10
Neurological disease e.g. epilepsy 10
Previous confirmed DVT/ Pulmonary embolism 10
3rd or 4th degree tear (be aware for delivery) 5
Shoulder Dystocia / Previous baby affected by Group B streptococcus –last birth (be aware for delivery) 5
2 or more caesarean sections 10
Post-partum hemorrhage, MRO (aware for delivery) 5
Previous baby with structural abnormality 10
 
4.    SURGICAL HISTORY
Criteria Score
Anesthetic Problem (be aware) 5
 Surgery to cx: cone biopsy/Letz, colposcopy 10
Uterine surgery such as myomectomy 10
Vaginal Surgery (TVI, TOT – be aware for delivery) 2
5.    FAMILY HISTORY
Criteria Score
Diabetes Type 1 and Type 2 – GTT at 28 weeks 0

 

 

 

Abu Dhabi (DOH) Policy:

 

1-Down Syndrome screening:

  • Combined test between 11 weeks 0 days and 13 weeks and 6 days
    • Nuchal translucency
    • Beta-human chorionic gonadotropin
    • Pregnancy associated plasma protein-A
  • Serum screening test (triple or quadruple test) between 15 weeks and 0 days and 20 weeks and 0 days
  • Screening for fetal anomalies only recommended for Down syndrome. For Trisomy 18 (Edwards syndrome) and Trisomy 13 (Patau syndrome), kindly check your policy. Generally the screening is included in the NIPT test.

2- Anomaly scan (18-20 weeks)

For a woman whose placenta extends across the internal cervical os, offer another scan at 32 weeks.

3- Coverage of new-born

within 30 days of birth under mother’s card for all services. Coverage can be extended to Out-Patient follow ups & visits within 30 days from birth.

4- Neonatal circumcision:

Check your policy.

Routine Antenatal Screening and Care
WEEK Screening
6-10 WEEKS

First Antenatal Visit
(ideally before 10 weeks)

 Confirming pregnancy: Pregnancy test

•        Rubella susceptibility, HIV, Varicella, Syphilis (RPR, VDRL), Hep B virus, CBC, Vit. D, Haemoglobinopathy screening***, ABO/Rh/Ab screen

•        Urine analysis

•        Cervical cancer screening***

•        Down Syndrome Screening(as per note 1)

•        If Chorionic Villus Sampling(CVS)* is medically indicated, this should be done between 11-14 weeks
16 WEEKS •        Urine analysis – dipstick

•        If Amniocentesis*, is medically indicated, this should be done after 16 weeks *

•        Unsensitized Rh-negative women require  RhoGAM
25 WEEKS

(only for women who never gave birth before)

 •        Urine dipstick – Proteinuria

•        Rho(D) Immune Globulin(RhoGAM)
28 WEEKS •        Gestational Diabetes Mellitus screening

•        Repeat Rh antibody screen

•        CBC

•        Urine dipstick- proteinuria

•        Hepatitis B Ag (if not done previously)

•        Rho(D) Immune Globulin (RhoGA)
31 WEEKS

(only for women who never gave birth before)

 •        Urine dipstick- proteinuria
34 WEEKS •        Urine dipstick- proteinuria

•        Rho(D) Immune Globulin(RhoGAM)
36 WEEKS •        Gestational Diabetes Mellitus screening

•        Repeat Rh antibody screen

•        CBC

•        Urine dipstick- proteinuria

•        Hepatitis B Ag (if not done previously)

•        Rho(D) Immune Globulin (RhoGA)
38 WEEKS •        Urine dipstick- proteinuria
40 WEEKS

(only for women who never gave birth before)

 •        Urine- proteinuria
41 WEEKS •        Urine- proteinuria

•        Ultrasound

•        Fetal assessment (ultrasound+ CTG)

 

 

 

Northern Emirates (Non-DHA & Non-DOH Policies):

 

Please check your policy for details.

 

 

For Healthcare Providers:

 

  • All maternity benefits, treatments and screenings require pre-authorization from Nextcare.

 

LOW RISK ANTENATAL CARE MODEL:
Week: Investigations: CPT:
10-14 weeks   Initial Ultrasound 76801
Genetic screening (Double or Triple Marker) Double test:

76813-84163-84704

Triple test:

82105 – 84704 -82677

Inhibin A:

86336 à Not Covered
CBC, FBC and Platelets 85025
Blood group, Rhesus status(INDIRECT COOMBS) & antibodies

(if negative, husband blood group and Rh status may be requested)

 86901/86886
VDRL (Syphilis test, non-treponemal antibody; qualitative) 86592
Urinalysis

Urine culture if any abnormalities in urine analysis.

 81001 – 81000

87088
Rubella serology 86762
FBS, random or HbA1c 82947
HIV 86703
Hepatitis B  –  HBsAg 87340 – 87341
Hepatitis C offered to high risk of hepatitis infection 86803
GTT if high risk in gestational diabetes member 82951
Thyroid (TSH): screening only not covered.

Covered if medically necessary only.

 84443
16 weeks Ultrasound. 76805
18-20 weeks Detailed anomaly scan 76811
25 weeks Ultrasound. 76805
Repeat GTT

GTT if high risk in gestational diabetes member for high risk patient if normal at first visit

 82951
28 weeks Ultrasound: Fetal growth surveillance 76816
FBC and Platelets 85025
Rhesus antibody screen

If Rhesus negative à give Anti D, one dose(28-30 weeks)

 86901
Fetal non-stress test for high risk pregnancies 59025
31 weeks Ultrasound: Fetal growth surveillance 76816
34 weeks Ultrasound: Fetal growth surveillance 76816
36 weeks Fetal growth surveillance 76816
If medically necessary à Low vaginal swab for group B hemolytic streptococcus 87070
38 weeks Fetal growth surveillance 76816
40 weeks Fetal growth surveillance 76816

 

 

References: