CurrentUnitedHealthcarePolicy BIP091.P

Maternity Newborn Care Ca

Defines UnitedHealthcare West coverage for maternity and newborn services including federally/state-mandated requirements, prenatal/postnatal care, inpatient maternity care, newborn care, maternal mental health screening and program requirements, and specified exclusions. Also incorporates California-specific statutes and programs.

Policy Summary

PayerUnitedHealthcare

PolicyMaternity Newborn Care Ca

Policy CodePolicy BIP091.P

Change TypeRevisions and additions (maternal mental health, doula coverage, PNS updates)

Effective DateApr 1, 2026

Next Review DateN/A

Key ActionIf mother/newborn discharged prior to the 48- or 96-hour minimum, the treating physician must decide in consultation with the mother and prescribe a post-discharge follow-up visit to occur within 48 hours of discharge; document decision and follow-up prescription.

SourceLink

POLICY UPDATE CHANGES

Revised language pertaining to the California Prenatal Screening (PNS) Program and HSC Section 1367.625.

Added language to indicate the services of a doula are covered when performed within the scope of their training as a doula.

Revised maternal mental health language to specify screening frequency and 12-month coverage limit.

Added definition of 'Postpartum'.

48/96Minimum inpatient stay vaginal / C-section

6wPostnatal office visit coverage window

12m

Max maternal mental health coverage

IncludedDoula services

Coverage Summary

Policy Number: BIP091.P. Subject: Maternity and Newborn Care. Status: CURRENT. Effective Date / Last Review: April 1, 2026.

High-level summary: This policy aligns UnitedHealthcare West coverage for maternity and newborn services with applicable federal and California statutory requirements (including the Newborns' and Mothers' Health Protection Act and California Health and Safety Code provisions). It defines covered maternity and newborn services (prenatal and postnatal care, inpatient maternity care including labor/delivery/recovery, minimum hospital stays, newborn care and special care nursery services, circumcision conditions, and related diagnostic and ancillary services), describes provider/network requirements (plan providers and network/participating CNM/CM availability and authorization), specifies maternal mental health screening and program requirements, and lists specified exclusions.

Covered maternity/newborn services (high level): Prenatal office visits; postnatal office visits up to 6 weeks (42 days) post-delivery; outpatient physician services; screening and diagnostic laboratory and radiological procedures (including the California Prenatal Screening Program); prenatal diagnostic testing and genetic counseling; inpatient hospital care for labor, delivery and recovery; alternative birthing center services arranged by a network hospital; treatment of miscarriage and pregnancy/childbirth complications; physician and ancillary services related to medically necessary inpatient maternity care; postnatal hospital services including special care nursery; and circumcision coverage under specified conditions. The services of a doula are included when performed within the scope of their training as a doula.

Provider and network requirements: Prenatal and postnatal care must be provided by a plan provider; services of a licensed/Certified Nurse-Midwife or Certified Midwife are covered only when available within and authorized by the member's network/participating medical group. If mother/newborn are discharged earlier than the NMHPA minimums, the treating physician must decide in consultation with the mother and prescribe/document a post-discharge follow-up visit within 48 hours.

Maternal mental health requirements: The plan incorporates California HSC Section 1367.625 requirements: at least one screening during pregnancy, at least one additional screening within the first six weeks postpartum, and additional postpartum screenings when medically necessary/clinically appropriate per the treating provider. Maternal mental health condition coverage shall not exceed 12 months from diagnosis or from the end of pregnancy, whichever is later.

Specified exclusions (examples): Childbirth classes and educational childcare courses; elective home delivery unless covered under federal/state mandated regulations; maternity services for a non-member acting as a surrogate for a member; newborn coverage of a grandchild except as employer-provided or where legal guardianship/placement for adoption is documented; non-medically indicated procedures such as sex-determination testing or paternity blood testing; non-medically necessary newborn carrier-status screening without immediate medical benefit; and take-home medications/supplies unless a supplemental pharmacy benefit applies.

Quick thresholds

Minimum inpatient stay (vaginal)>= 48 hours

Minimum inpatient stay (C-section)>= 96 hours

Postnatal office visit coverage windowUp to 6 weeks (42 days) post-delivery

Max maternal mental health coverage duration<= 12 months from diagnosis or end of pregnancy

Doula servicesIncluded when performed within scope of doula training

Medical‑Necessity Criteria — General

General coverage

Covered when ALL of the following are met:

ALL of the following

Services are medically necessary
Services are provided by a plan provider (including network/participating licensed/Certified Nurse-Midwife only when available within and authorized by the member's network/participating medical group)

Medical‑Necessity Criteria — Prenatal and Postnatal Care

Prenatal and Postnatal Care

Covered services include (examples):

ANY of the following

Prenatal office visits
Postnatal (after delivery) office visits up to 6 weeks post-deliveryup to 6 weeks (42 days) post-delivery
Outpatient (office visit) physician services
Screening and diagnostic laboratory and radiological procedures (including the California Prenatal Screening Program)

Medical‑Necessity Criteria — Inpatient Maternity Care

Inpatient Maternity Care

Covered when ALL of the following are met or as specified:

ALL of the following

Inpatient hospital care including labor, delivery and recovery room care, treatment, and services
Minimum 48-hour inpatient stay for normal vaginal delivery (unless earlier discharge decided by treating physician in consultation with the mother)>= 48 hours
Minimum 96-hour inpatient stay following delivery by cesarean section (unless earlier discharge decided by treating physician in consultation with the mother)>= 96 hours

Medical‑Necessity Criteria — Newborn Care

Newborn Care

Covered services include:

ANY of the following

Postnatal hospital services, including special care nursery

Immediate accident and sickness coverage from the moment of birth to each newborn infant of any subscriber or spouse (per HSC Section 1373(c)), with specified rules for adopted/placed children

Exclusions / Not Covered

Exclusions / Not covered

The following are NOT covered:

ANY of the following

Childbirth classes (e.g., Lamaze)
Educational courses on childcare
Elective home delivery unless covered under the Federal/State Mandated Regulations section
Maternity services for non-UnitedHealthcare member acting as surrogate to UnitedHealthcare member
Newborn coverage of a grandchild unless the employer provides the coverage or the subscriber/subscriber's spouse/domestic partner has guardianship as filed in a court or provides proof of placement for adoption

Referenced Regulations / Code References

Referenced federal/state regulations and programs (informational)mixed

45 CFR §146.101	Newborns' and Mothers' Health Protection Act (NMHPA) - Basis and Scope
45 CFR §146.130	NMHPA - Standards Relating to Benefits for Mothers and Newborns

Provider Actions

Documentation Required

Early discharge documentation and follow-up

If mother/newborn are discharged prior to the 48- or 96-hour minimum, the treating physician must decide in consultation with the mother, prescribe a post-discharge follow-up visit to occur within 48 hours of discharge, and document the decision and the follow-up prescription.

Follow-up visit within 48 hours
Document decision and prescription

Prior Authorization

Circumcision medical necessity review

Requests for circumcision outside the stated covered conditions must be reviewed for medical necessity by the network medical group or UnitedHealthcare medical director or designee.

Background and Definitions

Brief background: This policy summarizes and implements applicable federal and California statutory requirements for maternity and newborn care and aligns UnitedHealthcare West coverage accordingly. Key federal mandate: the Newborns' and Mothers' Health Protection Act (NMHPA) of 1996 prescribes minimum hospital stays of 48 hours after vaginal delivery and 96 hours after cesarean delivery, with allowance for earlier discharge if the attending physician, in consultation with the mother, decides. California statutes and regulations (including HSC sections) further specify direct access to OB-GYN services, coverage for the statewide California Prenatal Screening (PNS) Program, and other mandated services.

Provider and network requirements: Prenatal and postnatal care must be provided by a plan provider; services of a licensed/Certified Nurse-Midwife (CNM) or Certified Midwife (CM) are covered only when available within and authorized by the member's network/participating medical group. The plan must provide post-discharge follow-up within 48 hours when discharge occurs prior to the NMHPA minimum and such follow-up is prescribed by the treating physician.

Covered services (specific mentions): Prenatal office visits; postnatal office visits up to 6 weeks (42 days); outpatient physician services; screening and diagnostic laboratory and radiologic procedures (including participation in the California Prenatal Screening Program as required by HSC Section 1367.54); prenatal diagnosis of fetal genetic disorders and genetic counseling; inpatient maternity care (labor, delivery, recovery, related physician and ancillary services); alternative birthing center services when provided or arranged by a network hospital affiliated with the member's network medical group; postnatal hospital services including special care nursery; immediate accident and sickness coverage for newborns from the moment of birth per HSC Section 1373(c); and circumcision under defined hospital and post-discharge conditions.

Maternal mental health program: In alignment with California HSC Section 1367.625, the plan shall develop a maternal mental health program that includes at least one screening during pregnancy, at least one screening within the first six weeks postpartum, additional postpartum screenings as clinically appropriate, development of program guidelines provided to contracting obstetric providers, and encouragement of screening, diagnosis, treatment, referral, and enrollee education. The program may include coverage for doulas and other quality measures to improve maternal mental health care.

Revision History

04/01/2026materialLatest

Federal/State Mandated Regulations updated with revised language pertaining to the California Prenatal Screening (PNS) Program and California HSC Section 1367.625 (Maternal Mental Health Program).

04/01/2026material

Covered Benefits section updated to add that the services of a doula are covered when performed within the scope of their training as a doula.

04/01/2026material

Policy Summary

PayerUnitedHealthcare

PolicyMaternity Newborn Care Ca

Policy CodePolicy BIP091.P

Change TypeRevisions and additions (maternal mental health, doula coverage, PNS updates)

Effective DateApr 1, 2026

Next Review DateN/A

SourceLink

On This Page

Prenatal diagnosis of fetal genetic disorders including tests for specific genetic disorders for which genetic counseling is available

Educational materials for individual needs provided in physician's office

Maternal mental health program requirements

At least one maternal mental health screening conducted during pregnancy
At least one additional maternal mental health screening conducted within the first six weeks of the postpartum periodwithin first 6 weeks postpartum
Additional postpartum screenings when determined to be medically necessary and clinically appropriate, based on the judgment of the treating physician
Maternal mental health condition coverage shall not exceed 12 months from the diagnosis or from the end of pregnancy, whichever occurs later<= 12 months

If discharged prior to 48 or 96 hours, a post-discharge follow-up visit for mother and newborn will be provided within 48 hours of discharge when prescribed by the treating physicianwithin 48 hours of discharge

Alternative birthing center services when provided or arranged by a network hospital affiliated with the member's network medical group

Delivery by either normal/vaginal or cesarean-section (C-section)

Treatment of miscarriage and complications of pregnancy or childbirth

Physician services related to all medically necessary inpatient maternity care

All medically necessary ancillary services related to inpatient maternity care including diagnostic laboratory and/or radiologic procedures

Services of a licensed/Certified Nurse-Midwife only when available within the member's network/participating medical group

title": "Inpatient Maternity Care" ,

nodes2_added_circumcision": [ ] } , {

blocks_extra": [] } ,

Non-medically indicated diagnostic testing such as any procedure intended solely for sex determination (e.g., ultrasound)

Non-medically indicated blood testing to determine paternity

Non-medically necessary screening of newborns to determine carrier status for inheritance disorders when there would not be an immediate medical benefit or when results would not be used to begin medical interventions/treatment while a newborn

Take-home medications and/or supplies, unless member has a supplemental pharmacy benefit

Documentation Required

Use of CNM/CM

Services of a licensed Certified Nurse-Midwife (CNM) or Certified Midwife (CM) are covered only when available within and authorized by the member's network/participating medical group; providers should verify network availability and obtain authorization as required.

Documentation Required

Maternal mental health screening requirements

Providers must perform at least one maternal mental health screening during pregnancy and at least one within the first six weeks postpartum, document any additional screenings deemed medically necessary and clinically appropriate, and ensure treatment and referral pathways are documented.

California-specific programs and references: The policy incorporates the California Prenatal Screening (PNS) Program requirements (coverage without cost-sharing per HSC Section 1367.54) and references the PNS expansion and provider guidance (including cfDNA and MSAFP screening timelines) as applicable. It also references state provisions for donor human milk, newborn immediate coverage rules, and other state-mandated screening/treatment statutes as noted.

Exclusions and review processes: The policy lists specific exclusions (e.g., childbirth classes, elective home delivery unless otherwise required, non-medically indicated sex-determination testing, paternity testing, certain newborn carrier testing, and take-home medications/supplies without a supplemental pharmacy benefit). Requests outside defined coverage conditions (for example, circumcisions not meeting the stated criteria) must be reviewed for medical necessity by the network medical group or UnitedHealthcare medical director or designee.

Operational note: Benefits are listed in Federal/State Mandated Regulations, State Market Plan Enhancements, and Covered Benefits sections; all services must be medically necessary and subject to the member's Evidence of Coverage/Schedule of Benefits provisions.

Term	Definition
Certified Nurse-Midwife (CNM) or Certified Midwife (CM)
CNMs and CMs are educated in graduate-level midwifery programs accredited by the Accreditation Commission for Midwifery Education (ACME), pass a national certification exam administered by the American Midwifery Certification Board (AMCB), and provide care during pregnancy, childbirth, the postpartum period, sexual and reproductive health, gynecologic health, family planning services (including preconception care), primary care across the lifespan, and care for the healthy newborn during the first 28 days of life.
Newborns' and Mothers' Health Protection Act (NMHPA) of 1996
A federal law that generally prohibits restricting benefits for a hospital stay in connection with childbirth to less than 48 hours following a vaginal delivery or 96 hours following a cesarean delivery; applies to group health plans and health insurance issuers subject to state regulations.
Postpartum
Period of 12 weeks after a woman gives birth.
Postnatal
Begins immediately after the birth of the baby and extends up to six weeks (42 days) after birth.
Prenatal
The period during pregnancy before birth occurs.

Prenatal and Postnatal Care / Maternal Mental Health language revised to specify at least one screening during pregnancy, at least one within the first six weeks postpartum, additional postpartum screenings as clinically appropriate, and that maternal mental health condition coverage shall not exceed 12 months from diagnosis or from the end of pregnancy, whichever occurs later.

04/01/2026non-material

Definitions section updated to add the definition of 'Postpartum' (period of 12 weeks after a woman gives birth).