Many families are in search of affordable health insurance that will provide maternity or pregnancy benefits. Health carriers offer such plans, but they vary in the amount of coverage provided. Most insurers provide no benefits for at least three to nine months and at least one insurance company will not cover a pregnancy for 18 months.
As with all things insurance related, you must plan ahead. Occasionally, people call our agency once they are pregnant and are disappointed to learn insurance cannot be purchased to cover the pregnant spouse. Insurers simply will not take on this risk. However, a health plan can be purchased for a healthy mother and child after delivery.
Generally, policies will provide benefits for maternity after the insurance has been in force for at least three to nine months. If you were to purchase a plan, then shortly thereafter conceive a child, and the child was delivered before the policy had been in force for nine months, then your pregnancy would not be covered. Again, it is prudent to plan ahead and purchase a policy with a maternity rider some months before conception.
It might be helpful to look at this from the insurance provider’s point of view. Typically, when a couple desires and pays for a maternity plan, then they are likely to use it. The insurance company is relatively certain that a claim will come in the near future. Thus, they will build the cost into the premium for the insured (you) and mandate a waiting period. That being said, some companies are offering plans that are more attractive than others.
One insurance company offers a Health Savings Account (or HSA) maternity plan with a $1,500 individual deductible. Once the deductible has been reached and the nine month waiting period has been satisfied, the plan would cover the balance of the pregnancy.
In this example, you could fund the HSA account with at least the $1,500 and write that off against your income. The $1,500 could be withdrawn tax free to satisfy the deductible and then the policy benefits would kick in. Currently, this HSA plan is one of the more popular policies available.
(Our apologies – as of 2011 this plan is no longer offered)
Another popular plan has a three waiting period and its own maternity specific deductible. This coverage is typically more expensive as the maternity coverage beings earlier than most other plans.
(Our apologies, as of 2010 this plan is no longer offered)
The insured would have their own deductible, but both amounts might need to be covered under certain circumstance – like complications due to pregnancy. It is important to speak with a knowledgeable agent to understand the coverage.
At this point, clients often ask about prenatal care and doctor’s office visits. Fortunately, most Obstetricians do not charge as you go. Doctor’s visits, prenatal care and delivery are all included as part of the pregnancy and usually subject to one, predetermined charge. Thus, the final bill can be run through your insurance company (assuming you purchased a maternity rider) and then settled up.
The bottom line with health insurance policies and especially ones that cover pregnancy is that you must to plan ahead. There are only a few options available, but you will get the most from your policy if you research and purchase it ahead of time.
Editors note: By law, all plans must now cover maternity related expenses subject to their deductible. There are no longer waiting periods for the insurance to being, but you can only purchase health insurance during open enrollment unless you are experiencing a qualifying life event.
Category: Health Insurance