Most people consider pregnancy to be a blessing. Insurance companies, however, especially those that provide individual health insurance, consider pregnancy to be a pre-existing condition. What does this mean for consumers? It means that you should not assume that your individual health insurance is going to cover maternity care right now. This will change in 2014. Until then, check over the fine print on your insurance policy very carefully!
Right now, it’s extremely difficult to get approved for an individual health insurance policy if you are already pregnant. Most of the large for-profit insurance companies, like Aetna, Humana, UnitedHealth Group and WellPoint, will label that a pre-existing condition, and refuse to cover most of the cost of any medical care related to that pregnancy. A 2009 report by the National Women’s Law Center found that out of 3,600 individual health insurance policies, only 13% of them provided maternity coverage.
Some individual health insurance policies require consumers to purchase a special rider that will cover maternity care. What if you didn’t happen to purchase that rider? Well, in that case, you are going to have to come up with the money to cover your medical bills all by yourself, because your insurance policy will deny coverage. They may also choose to deny coverage to expectant fathers, and to families who are in the process of adoption. After the baby is born, however, then the insurance company may start providing coverage for that infant on his or her parent’s policy. But, not before the birth, when people need their insurance the most.
What if you get your insurance from your employer? Don’t assume that this policy will cover maternity care. If your company is small, with fewer than fifteen employees, be careful. The Pregnancy Discrimination Act of 1978 requires companies to cover the costs of maternity care for their insured employees. However, if the company has less than 15 employees, this law does not apply. This is why you need to read over the details about your insurance policy very carefully.
Fortunately, in 2014, this will change. The health care reform laws will require insurance companies to cover maternity care, because it falls under the category of “essential health benefit”. If your current health insurance policy doesn’t cover the cost of maternity care, and you aren’t quite ready to start a family just yet, you might want to wait until 2014. For everyone else, you might consider purchasing the maternity rider. Keep in mind, however, that many riders come with a waiting period before coverage will begin. The wait can be six months, or more.
Image by Gabi Menashe on Flickr