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Pregnancy can be the most exciting time in a woman’s life. She will be looking forward to the arrival of a new baby and that tiny living creature is growing inside her, getting bigger and stronger as the days go by, preparing to make a grand entrance, hopefully without complications. While being pregnant can be a wonderful adventure, it can also be a frightening time of facing the unknown, especially for first time mothers. The cost of giving birth has literally skyrocketed in recent decades and it is not unusual to spend anywhere from $8,000 to $10,000 for a ‘normal’ delivery with surgical ‘C-Sections’ running much higher. These estimates don´t even include pre and post natal care for mom.
Because of the high cost of giving birth, it has become increasingly necessary to carry pregnancy insurance either as part of a current health care plan in the form of a maternity or pregnancy ‘rider,’ or when purchasing a stand alone policy as primary or supplemental coverage. One thing to be aware of is the fact that if a woman is already pregnant and has no medical coverage, many health insurance companies consider that to be a preexisting condition and as such will not cover the pregnancy or the delivery of the baby. It is always best to purchase pregnancy insurance prior to conceiving to ensure adequate coverage. When choosing pregnancy insurance there are several areas that should be considered prior to binding the policy or rider. Following is a list of 10 things to look for when buying pregnancy insurance.
1. Already Pregnant – Pre-existing Condition Clause
Because most insurance companies will not write a policy for a woman who is already expecting, whether you are pregnant or not at the time of purchasing the clause should be a major concern. In the event that insurance coverage is denied based on the pre-existing condition clause there are government funded options available if certain income eligibility requirements are met.
2. Prenatal Care, Diagnostics and Lab Work
Pregnancy lasts a full forty weeks under normal circumstances. To ensure the health of baby and mom, it is imperative to get good prenatal care with all the diagnostics and lab work that are required during this time. Question whether ultrasound, blood work and other diagnostic tests are covered and to what percentage. Is there a co-pay, a maximum amount covered or a deductible?
3. In-Network Physicians (PPO)
Many health insurance policies are part of what is referred to as a Preferred Provider Organization which requires the insured to choose from a list of physicians that are part of the network. While it may be necessary to meet a deductible, or provide a co-pay amount with each visit, these are still the only doctors that are covered under the policy barring any mitigating circumstances such as the need for a specialist when none are available in-network.
4. Free Choice of Physicians (HMO)
Although there are many similarities between Preferred Provider Organization health insurance networks and Health Maintenance Organization (HMO) networks, the biggest difference is in the choice of doctors. When seeking pregnancy insurance from an HMO provider, there is greater freedom in choosing both the primary care physician and the obstetrician. Some HMO policies offer co-payment plans while others pay a percentage of each visit. This is something that should be questioned before deciding on a plan.
5. Alternative Medicine, Midwives, Home Births and Birth Centers
While many pregnancy insurance policies are limited to traditional prenatal and delivery practices, a greater number of insurance companies are covering more alternative treatments due to the cost factor. It is much less expensive to pay for alternative medical practitioners such as midwives and home births than it is to cover the rising cost of in-hospital deliveries and specialized physicians. Many moms prefer a more ‘natural’ or ‘holistic’ approach to birthing so this is a viable option to question.
6. Optional Coverages
If the pregnancy insurance is part of an existing policy then optional coverages are most likely already part of the plan. However, when pregnancy insurance stands by itself, optional coverage such as dental and vision may not be available. Some insurance companies make these optional coverages available while others will not offer them. This is something that should be seriously considered because many unrelated conditions such as an abscessed tooth can affect both mom and baby.
7. Prescription Medications
Many policies cover prescription medications such as prenatal vitamins and other medications necessary to keeping mom and baby healthy during pregnancy. There are times when mom is retaining too much fluid and diuretics or other medications need to be prescribed. Some health plans cover prescriptions with a co-pay, others reimburse all or a portion of out-of-pocket expenses, while still others make no previsions for pharmaceuticals.
8. 24 Hour Hotline/Dial-A-Nurse
Pregnancy is at best of times unpredictable. First time moms are often terrified by the smallest changes in her body and quite often these changes and physical ‘sensations’ are nothing to be alarmed at. Running to the emergency room or scheduling an emergency visit at the obstetrician’s office is considerably more expensive than providing an around-the-clock nurse’s hotline for mom to call with minor concerns. This service is provided for on many pregnancy plans.
9. Choice and Cost of Delivery and/or Hospital Stay
Many pregnancy insurance plans require the delivery to be performed at an In-network hospital while some plans allow moms more freedom of choice. This may also be a basic difference between a PPO and an HMO plan. Quite often the doctor and/or hospital portion of the plan only covers a percentage, has a deductible that must be met or carries a co-pay amount. This should be thoroughly questioned prior to signing a binder.
10. Postnatal Care
Most pregnancy insurance policies cover postnatal care for a certain amount of time following the birth of the baby. The length and amount of coverage may be dependent on factors directly related to the birth, such as whether there were any complications or if surgery was involved. Usually at least the first and/or second check-ups are covered following delivery but this is something that many people don’t think to ask about when choosing a plan.
Use the above mentioned as a guide and don’t be afraid to ask your insurance agent any other questions you might have. It is important to plan for every contingency so that you can truly enjoy this exciting moment in your life while being free from any unnecessary worries.
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