Health insurance covers 5 nights for pregnant women far from a maternity hospital

The decree of April 14, 2022, published in the Official Journal of April 15, 2022, sets up a service oftemporary non-medical accommodation for the pregnant women away from maternityprovision initially provided for in the Social Security Financing Act (LFSS) for 2020.

The decree sets the conditions of access and financing of this service and specifies the terms of payment of the corresponding transport costs.

TO NOTE

As the accommodation offered is not medicalised, no care can be provided there (except in an emergency).

Non-medical temporary accommodation: who can benefit from it?

Pregnant women residing more than 45 minutes away from a gynecology and obstetrics establishment can now benefit, if they request it, from temporary non-medical accommodation.

By way of derogation, accommodation may also be offered to pregnant women who, due to temporary circumstances (weather conditions, heavy road traffic, etc.), may lead to them being more than 45 minutes away from the obstetrics gynecology establishment on the planned date of arrival. ‘childbirth.

Accommodation is limited to 5 nights consecutive at most. They must necessarily precede the estimated date of delivery.

In the event of medical necessity, this period may be extended until the actual date of delivery. Similarly, in the event of a pathological pregnancy, this service can be offered at any time during the pregnancy. Its necessity and duration are then left to medical assessment under conditions that will be defined by decree.

TO NOTE

For pregnant women residing in Guyana, specificities apply.

Accommodation can be provided within the gynecology and obstetrics establishment in identified premises separate from the care and hospitalization areas or outside this establishment in premises dedicated to accommodation and located nearby.

The pregnant woman accommodated can decide to share her room with one or more companions (the spouse for example). However, this possibility is limited to the accommodation capacity of the accommodation structure.

Also, the performance of this service may be entrusted to a third party (another health establishment or any legal entity under public or private law) by means of an agreement.

Social security coverage

Non-medical accommodation is funded by health insurance for all pregnant women benefiting from the coverage of their health costs. For all the others, the service will be invoiced to them (as well as that for any accompanying persons).

The support is in the form of a flat rate per night and no contribution for accommodation can be requested in addition. A decree will come to fix the conditions of this financing and the amount of the lump sum.

Transport from the place of residence to the place of temporary non-medical accommodation or the gynecology and obstetrics unit for pregnant women is also covered by health insurance under certain conditions. On request, it is possible to have this transport carried out by an approved company or by a taxi company having concluded an agreement with a local health insurance body.

To benefit from this coverage, you must first seek the agreement of the Health Insurance.

TO NOTE

How to request a prior agreement from the Health Insurance?

  1. The doctor must give you a request for prior agreement, which is equivalent to a medical prescription for transport.
  2. You complete and send this request for prior agreement to the medical adviser of your health insurance fund.
  3. After your sending, the absence of answer within 15 days is worth agreement. In case of refusal, you will receive a letter from the Health Insurance.

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