Health Insurance Help
Maternity Health Insurance FAQ
Planning to have a baby can be an exciting and rewarding time in life. However,
it is a good idea to plan ahead in regards to your health insurance if you are planning
on trying to become pregnant in the near future. Below we have put together several
of the most common questions that come up as it relates to health insurance and
maternity coverage benefits.
Q: What if I need maternity coverage?
Q: What plan offers the best maternity protection?
Q: What if I think I'm already currently pregnant?
Q: What does capitated payouts mean?
Q: Which plans cover infertility treatments?
Q: What if I need maternity coverage?
A: Many consumers do not realize that maternity coverage is often excluded on individual
health insurance plans in California. In other words, Maternity coverage is NOT
automatically included on every voluntary individual health insurance plan in California.
If there is a chance that you may become pregnant in the future, then it is always
a good idea to purchase a plan before hand that includes coverage for maternity.
There are also several possible ways of insuring against the financial risk that
getting pregnant represents.
Q: What plan offers the best maternity protection?
A: You can apply for an HMO that covers maternity. Traditionally the HMO will have
lower copays at the doctors office, cover the costs of all labs, and tests, and
have a reasonable deductible or copay when you actually deliver. Also an HMO is
going to cover your newborn the best in the first year of life, when most baby wellness
visits, and scheduled shots occur. The drawback of an HMO is that your doctors selection
is reduced, and on an individual plan, an HMO is going to be more expensive monthly
than other alternatives. The next option would be to select a PPO plan that covers
maternity. This plan, although less expensive monthly than a HMO, will have higher
copays. Additionally, labs, tests, ultrasounds, etc. will usually be subject to
a deductible and coinsurance. The final option is to select an individual high deductible
health plan, also called an HSA plan that covers maternity. HSA's work basically
the same as PPO's except that everything is subject to a deductible before coverage
begins. For example, if your OBGYN charges $75 for an office visit, you are going
to pay the entire cost until the deductible is satisfied. After the deductible,
and any coinsurance portion that is required, then the HSA covers the rest of the
calendar year at one hundred percent.
Q: What if I am already pregnant?
A: It is not possible to get a voluntary individual health insurance plan that cover
maternity once you are already pregnant. Some other options to secure coverage include
setting up a small business group health insurance
plan, or going onto a state sponsored plan like
Access for Infants and Mothers (AIM).
Q: What does capitated payouts mean?
A: Capitated as it refers to HMO's and maternity means that the doctor gets paid
a set amount for both the number of patients under care, and predefined amounts
for specific health situation. For example if your doctors contract with your HMO
plan specifies capitated payouts, it means that your doctor may get a set dollar
figure for the number of patients they have. Plus they may receive a single payment
for a some specific medical conditions. For example in a pregnancy without any complications
the OBGYN may be compensated a single lump amount for providing all care for the
duration of the pregnancy. Many consumers find capitation contrary normal capitalistic
economic principals, and some people complain that the quality of care on HMO plans
suffers for it.
Q: Which plans cover infertility treatments?
A: If you are already diagnosed with a condition relating to infertility it is considered
a pre-existing condition. Depending on how recently
you have sought treatment, and the level of treatment rendered, there is a possibility
of being surcharged additional premium (25-50%), or even possible declination due
to the pre-existing condition. In complicated cases, we always recommend seeking
the help of one of HealthInsurancePlus.com's licensed professionals. Based on your
responses we can determine which carrier and which plan may be the best fit. Then
you can apply with confidence. We have an excellent approval rate on submitted applications.
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