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. Many insurers will not provide benefits to the insured for at least nine months.
As with all things insurance related, you must plan ahead. Occasionally, consumers are interested in maternity policies once they are already pregnant. They are disappointed to learn insurance cannot be purchased to cover a pregnant spouse – pregnancy is a preexisting condition. Insurers simply will not take on this risk. However, a health plan can be purchased for a healthy mother and child after delivery.
When is My Pregnancy Covered?
Generally, policies will provide benefits for maternity after the insurance has been in force for nine months, but some carriers offer plan with limited benefits that begin day one. However, if you were to purchase a plan with a nine month waiting period, your pregnancy would not be covered if the child was delivered before the nine month window had expired. 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.
A Popular HSA Maternity Plan with a Reasonable Deductible
One insurance company offers a Health Savings Account (or HSA) with a maternity rider and a low $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 The $1,500 could be withdrawn tax free to satisfy the deductible and then the policy benefits would kick in.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.
Another popular plan has no waiting period and provides more benefits the longer the policy is held. The maternity rider will cover $2,000 toward a pregnancy in the first two years. During years three and four, the policy will pay up to $4,000 and years five and on the policy provides coverage up to $6,000.
Another option is to simply self insure for a pregnancy. Many consumers will purchase traditional health insurance or possibly an HSA qualified plan and save each month in order to cover maternity expenses.
How are Pregnancies Billed?
At this point, clients often ask about pre-natal care and doctor’s office visits. Fortunately, most Obstetricians do not charge as you go. Doctor’s visits, pre-natal care and delivery are all included as part of the pregnancy and usually subject to one, pre-determined charge. Thus, the final bill can be run through your insurance company (assuming you purchased a maternity rider) and then settled up.
When purchasing health insurance policies covering pregnancy, you must plan ahead. There are several options available, but you will get the most from your policy if you do your due diligence and purchase the policy ahead of time.
Request a Health Insurance Quote with Maternity
By: Adam Hyers
Posts Tagged ‘Preexisting Condition’
Health Insurance Plans Covering Maternity
January 12th, 2010Health Insurance For Someone With Pre-Existing Conditions
November 10th, 2009
If you have you been rated up or declined for health insurance it’s probably because you have a pre-existing condition.
Thousands of uninsured, underinsured and uninsurable individuals are facing serious health issues like heart disease, heart attack, diabetes, cancer, stroke, liver disease, AIDS, pregnancy, depression and kidney disease. Any of these pre existing conditions can cause them to be declined for health coverage. Today, you may even be declined if you are over-weight.
It’s a real challenge obtaining health insurance for someone with pre existing conditions. However, before we get ahead of ourselves, here are some questions we need to address.
What is a pre-existing condition?
A pre-existing condition is any injury or sickness for which diagnosis has been made, treatment has been recommended, treatment has been rendered, or expenses have been incurred within a set amount of months prior to the effective date of coverage (usually 3, 6 or 12 months and this can vary by state). It includes any condition manifesting itself in symptoms which would cause a prudent person to seek medical advice.
What is a pre-existing condition exclusion period?
Insurance companies try to discourage people from waiting until they get sick to purchase medical insurance. This is accomplished by imposing what is known as a preexisting condition exclusion period. This simply means, if you have a medical problem which exists at the time you purchase insurance, the insurer will deny the claims pertaining to that medical problem for a certain period of time.
The rules governing preexisting condition exclusion periods in individual health policies vary widely from state to state and are very much different from the rules of an employer-sponsored plan. If you have or recently have had health coverage, you may be able to apply this creditable coverage to offset a preexisting condition exclusion period.
Why all the hoopla over a pre-existing condition?
The biggest stumbling block with private individual medical insurance is the problem with preexisting conditions. Plain and simple… insurance companies don’t like preexisting conditions. They know in the long run… it will cost them more money to insure you. Frankly, insurers prefer to insure people who are not very likely to need the insurance.
But stop and think! Who doesn’t have some kind of health or medical issue? It may be something as simple as asthma or as complex as cancer. Some pre-existing conditions can be managed and these individuals can live a relatively healthy and normal life.
Yet, insurers can and do turn down “high risks” individuals for coverage because of an existing or previous illness. Even if coverage is found, the premiums charged are often unaffordable. Sometimes the individual may end up with a modified policy paying more because of their medical history or having to take a policy that excludes their pre existing conditions.
Are there things I can do to get healthcare coverage?
Here are some choices for obtaining health coverage. See if any apply to your situation.
(1). Employer-sponsored group health plan
(2). Join a professional organization (e.g. Chamber of Commerce)
(3). Individual health insurance
(4). State risk pool (if one exist in your state)
(5). Discount health cards
(6). Guaranteed Issue Health Insurance
Whether covered by insurance or by some other means, the total cost of health insurance for someone with pre existing conditions is high enough to dramatically impact that person’s lifestyle.
Today it is important for all of us to lead a healthy lifestyle. However, if you already have a preexisting condition that is keeping you from getting affordable health coverage, you should investigate the 6 options listed above to see which would work best for you.
By: Rudy Wilson