Maternal and Child Health
Plan Benefit Model:
Evidence-Informed Coverage
2
Maternal and Child Health Plan Benefit Model
Index of Services
I. Recommended Minimum Plan Benefits: Preventive Services Page 35
a. Well-Child Services
b. Immunizations
c. Preventive Dental Services
d. Early Intervention Services for Mental Health / Substance Abuse
e. Preventive Vision Services
f. Preventive Audiology Screening Services
g. Unintended Pregnancy Prevention Services
h. Preventive Preconception Care
i. Preventive Prenatal Care
j. Preventive Postpartum Care
k. Preventive Services (General)II. Recommended Minimum Plan Benefits: Physician / Practitioner Services Page 47
a. Services Delivered by a Primary Care Provider
b. Services Delivered by a Mental Health / Substance Abuse Provider
c. Services Delivered by a Specialty Provider or Surgeon
d. E-Visits and Telephonic VisitsIII. Recommended Minimum Plan Benefits: Emergency Care, Hospitalization, and Other Facility-Based Care Page 51
a. Emergency Room Services
b. Inpatient Substance Abuse Detoxification
c. Inpatient Hospital Service: General Inpatient / Residential Care (Including Mental Health / Substance Abuse)
d. Inpatient Hospital Service or Birth Center Facilities: Labor / Delivery
e. Ambulatory Surgical Center or Outpatient Hospital Services
f. Mental Health / Substance Abuse Partial-Day Hospital (or Day Treatment) or Intensive Outpatient Care ServicesIV. Recommended Minimum Plan Benefits: Therapeutic Services / Ancillary Services Page 59^
a. Prescription Drugs
b. Dental Services
c. Vision Services
d. Audiology Services
e. Nutritional Services
f. Occupational, Physical, and Speech Therapy Services
g. Infertility Services
h. Home Health Services
i. Hospice Care
j. Durable Medical Equipment, Supplies, Medical Foods
k. Transportation ServicesV. Recommended Minimum Plan Benefits: Laboratory Diagnostic, Assessment, and Testing Services Page 75
a. Laboratory Services
b. Diagnostic, Assessment, and Testing (Medical and Psychological) Services