Read ChildbirthClassReimbursement.pdf text version

A healthy pregnancy starts with good information.

A childbirth education program offers a variety of classes to help you prepare for the birth of your baby. Whether you are getting ready for your first child or your family is growing and you need a refresher course, you can find classes that prepare and support you for welcoming your new baby. Childbirth education classes are available to you and your partner or support person free of charge at many primary care sites and hospitals. Speak to the provider caring for you during your pregnancy or the facility where you plan to deliver, about enrolling. If they do not offer a childbirth education program, Neighborhood Health Plan (NHP) will reimburse you for the cost of these classes up to $130 per pregnancy.

Questions?

Call the NHP Customer Service Center at 1-800-462-5449 (TTY 1-800-655-1761) if you have any questions about obtaining your reimbursement for qualifying childbirth education programs.

Childbirth education

For more information, visit nhp.org or call the NHP Customer Service Center at 1-800-462-5449 (TTY: 800-655-1761) Monday through Friday from 8:00am to 6:00pm, Thursdays from 8:00am to 8:00pm.

nhp.org

What will NHP cover?

Eligible childbirth education classes include breastfeeding classes, parenting classes, infant CPR classes, and childbirth classes (including refresher classes). You can combine multiple classes up to the $130 limit per pregnancy. (For example, you can take a $70 childbirth class and a $60 breastfeeding class). Reimbursement up to $130 is offered for each pregnancy.

NHP Childbirth Education Reimbursement Form

Member Information

MEMBER LAST NAME MEMBER FIRST NAME

NHP will pay for your childbirth education class for up to $130 for each pregnancy. Requests have to be made by March 31 of the following calendar year. Requests received after this date will not be eligible for reimbursement.

MIDDLE INITIAL

MEMBER STREET ADDRESS

MEMBER CITY

STATE

ZIP CODE

How do I get reimbursed?

You can get reimbursed only if you complete the course(s). You must submit a certificate of completion, a copy of the bill for the course, and proof of payment. Please allow 4-6 weeks for your reimbursement check.

MEMBER ID# (LOCATED ON THE FRONT OF THE NHP ID CARD)

MEMBER TELEPHONE NUMBER

Where did you take your class?

NAME/ADDRESS/TYPE OF FACILITY AMOUNT REQUESTED .

Send your information to NHP at the following address: Neighborhood Health Plan Claims Department 253 Summer Street Boston, MA 02210

Certification/Authorization/Reimbursement

Reimbursement is subject to approval by Neighborhood Health Plan. The member or the member's guardian must sign and date this form below. To the best of my knowledge and belief, my statements in the Reimbursement Form are complete and true. I am claiming reimbursement only for eligible expenses incurred during the applicable calendar year and for eligible members. I certify these expenses have not previously been reimbursed in this or any other calendar year.

MEMBER'S SIGNATURE DATE

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