Maternity Coverage 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 repesents.
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 occure. The drawback of an HMO is that your doctors
selection is reduced, and on an individul 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 capatated payouts, it means that your doctor may get a set dollar
figure for the number of patients they have. Plus they may recieve a single payment
for a some specific medical conditions. For example in a pregnancy without any complications
the OBGYN may be compinsated a single lump amount for providing all care for the
duration of the pregnancy. Many consumers find capatation contrary normal capatialistic
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 alway recommend seeking
the help of one of HealthInsurancePlus.com's licensed professionals. Based on your
responses we can determin 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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