Growing Family Benefits
- Don't get pregnant without us!
- Enjoy security for your family
- Ask for employee paid options at work
Individual Medical Plans with Maternity Coverage
Individual medical plans with maternity coverage often come packaged with a rider: a long waiting period before you can become pregnant, or a big deductible you must satisfy before you are eligible for benefits. Individual plans with a rider may be the only coverage option for couples who don’t have employer sponsored health plans.
Insurance companies want to take in more in premium than they pay out to healthcare providers. Group medical plans cover pregnancy with no rider, waiting period, or deductible because most employees are not planning to get pregnant. They can make money on your co-workers.
- Know State Laws: Does your state require maternity coverage?
- Define Coverage Holes: How rider deductibles and waiting periods work
- Fill Gaps: with supplemental coverage available in every state
Supplemental Insurance No Waiting Period Individual maternity insurance with no waiting period or deductible is available in all 50 states. Make sure you purchase your policy before getting pregnant. That is your most important exclusion. Get first dollar benefits for normal pregnancy when delivery occurs 9 months after the policy effective date.
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Individual Medical Coverage by State: Maternity Options
Eighteen states mandate individual and/or small group maternity coverage. Some mandate coverage, while others require only that insurers offer a medical plan that provides pregnancy benefits. Some state mandates apply to individual policies, while others apply only to small group coverage. Know the rules in your state.
Keep in mind these laws are telling the insurance company that if they want to do business in their state, they must offer policies that lose money. If you live in a mandate state, you are in luck. Without a law requiring coverage the remaining option will be an individual rider plan. Individual rider plans allow the insurer to make money on most policies.
Personal Maternity Coverage That Fills Holes
Supplemental maternity insurance provides a solution that fills holes in many individual insurance plans. There are no waiting periods to satisfy before getting pregnant, and no deductibles to meet before benefits begin. Normal pregnancy is covered, along with complications, and premature birth. These policies provide the ideal middle ground for many families whose employer does not offer a group plan.
Individual policies leave enormous gaps because of the expected loss ratios, so insurers insulate themselves with deductibles and waiting periods. You can get coverage for a planned medical event, and take advantage of the medical loss ratios for yourself: group coverage with pregnancy benefits sold as individual policies. Get the best of both worlds.
Individual Maternity Rider Policies
Individual medical plans with maternity coverage is your next option if you can't get coverage through an employer. Many employers choose not to offer health insurance because there is a direct cost: insurers require that employers pay a percentage of the premium.
Without a federal law mandating coverage for pregnancy in the individual market insurers allow adverse selection to drive their benefit offerings. Adverse selection suggests that couples planning a pregnancy cost far more to insure, and are far more likely to buy coverage.
Health insurance companies protect themselves from adverse selection by offering riders. Riders are an optional benefit to cover your normal pregnancy, labor, and delivery. Since insurers know that you plan to use the benefit, they structure the rider in a way that brings in more premium than they pay in benefits: long waiting periods, and large deductibles.
For couples looking to get pregnant very soon, a rider with a one year waiting period doesn't fit. Who wants to wait this long before getting pregnant? Also, you must pay six or twelve months of premium in advance of conception. If you get pregnant before the waiting period is met you prenatal care may not be covered. If conception is delayed you paid extra for the rider with nothing in return.
Plans with a large deductible also means paying more in extra premium than you might ever receive in benefits. In addition to paying the premium you may be left with a large bill to pay yourself after delivery. A plan with a deductible will likely pay little for normal prenatal care, labor and delivery.
If you get pregnant and experience complications your regular medical plan may cover your costs - whether you have a maternity rider or not. Your big exposure relates to your child. If your child is born prematurely, or is seriously ill your individual plan may not provide coverage, unless you purchased the rider. A few days in a Neonatal Intensive Care Unit (NICU) can leave couples with staggering expenses.
