10.02.2015

Planning for pregnancy health insurance

The last thing you want to think about when you or your spouse is pregnant is health insurance. And for many expectant parents, having a health insurance policy in place doesn't equate to pregnancy coverage. Although coverage for maternity care is required under the Pregnancy Discrimination Act of 1978, the law doesn't apply to companies with fewer than 15 employees or to individual policies, according to the Kaiser Family Foundation. Further complicating matters: Finding insurance after you become pregnant can be difficult (if not impossible) and expensive. If you aren't yet pregnant but are planning on it, start looking for individual health insurance policies now. A 2009 study by the National Women's Law Center of 3,600 individual health policies found that just 13 percent included maternity coverage.
If you already have health insurance, check your policy now if you're thinking of getting pregnant, says Susan Pisano, vice president of communication for America's Health Insurance Plans, a trade group for health insurance companies. Some additional benefits for pregnant women are part of the federal health care reform bill that took effect in 2010. In most states, just because health insurers can offer maternity coverage doesn't mean they're required to do so.


The income levels to qualify are higher for pregnant women than for regular Medicaid patients, says Brigette Courtot, a senior health policy analyst at the National Women's Law Center in New York City.
Group policies for all but the smallest groups (and individual plans) cannot treat pregnancy as a pre-existing condition, Courtot says. However, Courtot says that most such policies do not include pregnancy as a matter of course, but rather as a rider that can be added to a policy.
In other words, 87 percent of health insurance plans did not offer any maternity coverage, even through riders, as a general rule. Courtot notes that beginning in July 2010, every state was required to develop a plan available for those with pre-existing conditions who have not been insured for at least six months and have been denied coverage. In fact, a rule may declare that pregnancy is not a pre-existing condition, but that doesn't obligate a health insurer to supply maternity coverage.
So if an employer's health plan does offer pregnancy coverage, the plan can't deny coverage to a pregnant woman by saying she already was "sick" when she applied for insurance. Brad Imler, president of the American Pregnancy Association in Irving, Texas, also suggests contacting physicians and hospitals to set up a prepayment program as you prepare for the birth of your child. Again, these can be expensive and can include extremely limited coverage based on a trouble-free pregnancy and uncomplicated vaginal birth, according to Courtot.


In 2010, 12 states mandated coverage of maternity care in the individual insurance market and 17 required it in the small group market, according to the Kaiser Family Foundation. Potentially, a newly pregnant woman who seeks insurance and is denied coverage may -- at the end of her pregnancy -- be eligible for such a plan. Many companies, such as Starbucks, offer health insurance benefits even for part-time employees.
In one case, she tells of a pregnancy insurance plan that required a 20 percent co-pay and a $2,000 limit on coverage in the first two years, rising to only $6,000 by the fifth year. In 2014, plans will be banned from denying coverage based on pregnancy and can't discriminate against a person by determining she has a pre-existing condition. Courtot says that even if pregnancy is an "essential benefit," the coverage may not be as comprehensive as some advocates would like, it may not be mandated for individuals or very small groups, and the coverage may be prohibitively expensive.



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