ncluded in a
membership since the adoption, and the adopting parents were unaware of the condition at the
time the adoption was finalized.
(m) Heart Conditions.
Heart Conditions are sharable unless related to a heart condition you had prior to becoming a member,
and it does not come within the exceptions described in Section VII. During the first 36 months of
membership, a Confirmation of No Prior Existence of Condition statement may be required.
(n) Hemorrhoids.
Hemorrhoids are generally sharable, but during the first 36 months of membership, a Confirmation of No
Prior Existence of Condition statement may be required.
(o) Hereditary Diseases.
Hereditary Diseases are sharable under the same conditions as Genetic Defects.
(p) Hernia.
A Hernia is generally sharable, but during the first 36 months of membership, a Confirmation of No Prior
Existence of Condition statement may be required.
(q) High Blood Pressure.
As long as you have not been treated in a hospital for high blood pressure in the past four years, and you
have been able to effectively and continuously control this condition through medication or diet, an
incident that begins after your membership begins is sharable.
(r) Pregnancy/Maternity.
For a member who has been a Sharing Member continuously for at least twelve (12) months prior to
conception, medical expenses for Maternity are eligible for sharing, subject to the applicable Annual Non-
Sharable Medical Amount, as follows:
i. Up to $5,000 per-pregnancy limit for a normal delivery or a cesarean section that is not medically
necessary (whether for a single or multiple birth pregnancy), including but not limited to charges
and expenses arising from physician care, hospital or birthing center admissions, attendance by
midwives, or home deliveries accompanied by a midwife or physician.
ii. Up to $8,000 per-pregnancy for Maternity ending in a delivery by cesarean section that is
medically necessary because of complications that arise at the time of delivery (whether for a
single or multiple birth pregnancy).
iii. Up to $50,000 or the Program’s Annual Sharing Limit per pregnancy for Maternity ending in a
natural delivery or cesarean section, for combined expenses for the member and newborn arising
from complications at the time of delivery that threaten the life of the member or infant andUHFR093021E100121 Page 113
requiring care or services not normally rendered at the time of delivery (whether for a single or
multiple birth pregnancy).
iv. In the case of an ectopic pregnancy diagnosed before a rupture, expenses eligible for sharing
include costs of pre-operative tests, consultations and other expenses for keeping the member
under medical care while determining what care should be offered for the Member and Child. In
the case of an ectopic pregnancy th