Tori's Blog

What Is Your Maternity Medical Coverage?

Monday, March 6th, 2017

All the recent controversy over a new health care plan has reminded me about the maternity medical coverage items you’ll want to investigate with your own insurance company.

• Does your plan cover prenatal and maternity care? Federal law requires that an employer with more than 15 employees offer such coverage.

• Do you need “preauthorization” from the insurance company for prenatal or maternity care? Do you need to contact the health insurance company when you’re admitted to the hospital or birth center?

• Do you need a referral from your primary-care doctor to see an obstetrician? Can you make the obstetrician your primary-care doctor?

• Will your plan cover care from a nurse-midwife?

• What are the plan’s policies regarding in-network and out-of-network health-care providers?

• What is the coverage for prenatal lab tests, diagnostic studies, ultrasounds, and amniocentesis?

• Does the plan cover medications that may be needed during your pregnancy?

• Does your plan require that you give birth at a particular hospital? If so, you’ll want to be certain that your physician or midwife practices there.

• Will your plan cover birth at a birth center or at home?

• Do you have a deductible? If so, how much of it has already been met? Is there a separate deductible for pregnancy?

• Is there a copayment for office visits? If so, how much is it?

• How long a stay in a hospital or birth center does the plan cover? How many days are allowed for a cesarean birth and a vaginal birth? Will the plan cover an extended stay if it is medically necessary?

• After your baby is born, do you need to alert the insurance company immediately, before going home from the hospital or birth center? Many companies automatically provide coverage for a newborn if she is added to the plan within 30 days of birth.

• Which local pediatricians are within the plan’s network?

• Does the plan cover your baby’s hospital stay? What if the baby needs intensive care?

• Does the plan cover well-baby checkups and vaccinations? Will you have a copayment, and if so, what will it be? If you lose or quit your job, or if your spouse does, be very aware of how your insurance coverage may be affected. If you are switching to a new company, there may be a waiting period before your new benefits begin, and your care provider and choice of birthplace may not be covered under the new plan. It can be very hard to switch practitioners midway through your pregnancy. Thanks to the COBRA Act of 1985, you can stay on your former company’s health insurance plan for between 18 and 36 months if you have been fired, laid off, or given a decrease in work hours or status.

This is a pretty thorough list but you may want to speak with you medical benefits coordinator at your workplace as well.

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