Private Maternity Insurance

If you plan on having a baby, you will need maternity insurance coverage.  A 2007 report by the Kaiser Family Foundation estimated the costs of childbirth for a normal pregnancy at nearly $8000.  The Kaiser Foundation figure included hospitalization and physician fees for delivery, and office visits to the OB-GYN for prenatal and postnatal care.  In reference to maternityinsurance.orga pregnancy with complications could cost much more.  Moreover, the costs are likely to rise in the future.
If you expect to become pregnant in the near future, and you are already insured through your job or your spouse’s job, be sure to check whether your existing plan includes maternity coverage.   You might be unpleasantly surprised.

Whether an employer provides maternity coverage depends on several factors — the size of the company, the length of time you’ve worked there, and the number of hours you work.   Small companies often cannot afford to offer employees and their families the most comprehensive health plans.  Part-time workers at even the largest companies may not receive the same level of benefits as full-timers.  Furthermore, should you decide to take maternity leave, your coverage might not continue after you stop working unless  (1) you’ve been employed at the firm for more than a year and  (2) you are covered under the Family Medical Leave Act.

If you or your spouse work for a company with fewer than 100 employees, or you work less than forty hours a week, or you’re a new employee, there’s a good chance that maternity is not automatically included in your health plan and you may need to add a rider and pay extra for it.   It might also be necessary to send the insurer a written declaration with the date when you expect to give birth.  A stipulation of many maternity care riders is that pregnancy and birth are only covered after a waiting period of up to 12 months before the birth.  Moreover, some plans mark the end of the waiting period with conception, while others mark it as the date a baby is actually born.

You may be in luck if you work full-time for a larger employer with more than 100 employees, and you’ve been there for more than a year.   Your insurance plan in this situation is the most likely to cover maternity.  It is still important to check your policy, however.

If you plan to have a child and for any reason, you don’t already have maternity coverage, the best option is to purchase it before becoming pregnant, as an add-on or “rider” to a comprehensive health insurance plan.  There are two reasons for this.

First of all, if you wait to purchase insurance until after the pregnancy has begun, you will have trouble finding any maternity coverage at all because the pregnancy itself is considered a “pre-existing condition” by most health insurance plans.

Secondly, private insurance plans that cover only maternity costs are very few and hard to find.   The well-known “Maternity Card” from AHCO, which came on themarket in 1994, is no longer available as of 2009.

One valuable resource in locating affordable maternity coverage is a website, http://www.ehealthinsurance.com, that allows you to compare prices and benefits for different types of health plans. Basic health coverage for a family of four without maternity coverage might cost up to $500 a month with a $500 deductible.  Adding a maternity rider could raise the costs by more than $100 a month.   The costs vary, however, by geographic location and by the amount of coverage purchased.

Some nationwide health insurance companies, such as Anthem Blue Cross and Blue Shield, offer inexpensive maternity benefits in many states, but even Blue Shield may not be the best option in your area.  As a rule of thumb, before you purchase any kind of insurance, compare the prices and benefits of at least three maternity plans that are available in your zip code.

In addition to the price tag for a plan, an important consideration in itself, there are several questions to consider when shopping for pregnancy insurance. First of all, what is the extent of coverage provided? It is important to keep in mind that a good private maternity insurance plan should cover visits to the doctor during pregnancy, hospital stays during labor and delivery, and follow-up care after the birth to make sure the newborn baby is healthy.

Secondly, what are the rules on insurance payouts?     The percentage of your expenses reimbursed by the plan could range from 50% to 100%.   What is the lifetime maximum it will cover?   Some pregnancies are more expensive than others because of birth complications; a low lifetime limit will limit the value of the plan.

Thirdly, what state do you live in, and what laws about health care apply in that state?  Sometimes state laws can be your friend if you are expecting a baby, because they may require health plans to provide at least 31 days of coverage for newborn babies, beginning on the date of birth. One federal law, the Newborns’ and Mothers’ Health Protection Law, guarantees a minimum stay in the hospital after birth for mothers and their newborns, an d some states have hospital stay requirements that are even more stringent than the federal law.

There is a final option to consider, should adequate maternity insurance be impossible to find, and your income be too high to qualify you for any government-funded programs like Medicaid, WIC or state benefit programs.  Some small businesses offer Health Savings Accounts (HSAs) which allow you to set aside $5000 in non-taxable income for medical expenses, including any maternity-related doctors’ fees, hospital stays and the like.   This strategy, too, requires some advance planning, and it may not be much help if complications with your pregnancy send your costs spiraling out of control.  However, the opportunity to set aside $5000 in tax-free income for childbirth costs is certainly better than nothing.

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