Far too many parents simply assume their new baby will automatically be covered by the family’s existing
health care insurance. The expenses of an addition to the family, however, start while the child is in the womb (and they don’t go away.) This is not just a women’s health insurance issue, but a family issue. There are the costs of prenatal care and the delivery to be considered, as well as pediatrician weigh-ins, vaccinations, and the occasional prescription during the child’s first year of life.
The best strategy is to investigate the applicable provisions of your coverage when you decide to begin trying to have a family, however, we all know that surprises happen. Once you do discover that a baby is on the way, make evaluating your coverage a high priority.
It’s important to understand that under the terms of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), group health plans cannot treat pregnancy as a pre-existing condition. The legislation was established to prevent insurance companies, group health plans, and HMOs from discriminating in the provision of health care benefits.
That being said, if you replace one individual health policy for another, or switch from a group to an individual plan, you may sacrifice pregnancy coverage or be forced to wait several weeks for your new coverage to become activated. If your insurance coverage isn’t going to adequately cover your pregnancy and your baby’s health care, it’s better to switch individual coverage plans before you’re actually pregnant.
Some questions you will want answered include:
- Are prenatal and maternal care covered?
- Will pre-authorization for prenatal or maternal care be required?
- When you are admitted to the hospital for your delivery are you required to inform the insurance company? (Some plans may penalize you if you don’t.)
- What are the rules regarding health care providers outside the plan’s network if you have a specific preference for a doctor?
- Will a primary care physician have to refer you to an obstetrician?
- Are ultrasounds and amniocentesis procedures covered?
- What length of post-delivery hospital stay is allowed?
- If a longer stay is medically necessary, will it be approved?
- Is there a reimbursement limit?
- Are “well baby” doctor’s visits, check-ups, and immunizations covered?
Finally, find out how long you have after your child is born to formally add the baby to your coverage. Usually, a newborn will be covered for the first 30 days of life automatically, but if the parents have not gone through the necessary paperwork to add the child to the policy after that, benefits may be denied.
Finding out that there’s a new addition to the family on the way is exciting news, leading most parents to think about anything but insurance. It’s important to pause in the midst of the euphoria and take the time to learn exactly what coverage benefits you have and if any changes need to be made or can be made.
You’re facing prenatal and delivery expenses, in addition to all the necessary health care of your child’s early years. Make sure you’re covered, so your attention can be where you want it to be, on your new son or daughter.
