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What you need to know before buying Health Insurance  

Is pregnancy a Pre-Existing condition? Maternity Insurance

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Maternity Health Insurance

So, you want to get pregnant? Plan ahead.

Congratulations! For most couples, having a baby is the best moment of their lives. But for some, it can also be a worrisome time if their current health insurance policy has no maternity coverage or worst yet they have no health insurance plan at all. If you have employer sponsored group health insurance more than likely it has maternity coverage; but, unlike most individual health insurance policies, maternity is an optional benefit and can only be added at the point of application.

Plan your maternity ahead

There are few health insurance carriers in the industry today that will permit the coverage to be added after the policy has been issued; but, only if you're not pregnant. Otherwise, it is considered a pre-existing condition. In general, a pre-existing condition is a medical condition that manifests itself during a period of time prior to the policy's effective date with carriers either accepting or declining it for coverage. In the case of pregnancy, it is safe to say, that there are no major medical carriers that will accept you or your spouse if you are pregnant. In group health insurance policies, maternity isn't treated as such and coverage is available as long as the policy remains in force.
If you're planning a family and you reside in a state that doesn't mandate maternity coverage on individual health plans - pay a little extra premium and get it! As stated prior, individual health insurance plans do not automatically offer maternity as part of the basic benefits in their plan offerings while others don't offer it at all. For those insurance carriers that do offer maternity, it's usually treated as an optional benefit and must be selected prior to planning a pregnancy. Be prepared to have a waiting period imposed on the benefit prior to use. Dependant on the carrier or state mandates, it may range from 90 days to 12 months. A waiting period is a specified allotment of time that must lapse prior to activating the benefit starting from the effective date of your policy.

Not all Maternity Health Insurance coverage is alike

Maternity plan offerings vary in coverage. There are some with benefit specific deductibles, copayments, percentages, different waiting periods, and limitations. For example, you may have a carrier that offers up to $5,000 maximum in maternity coverage provided that you have been member for at least two years; while another will cover you at 100% of the covered expenses after the waiting period. Your choice in maternity coverage will determine if you will have any additional out-of-pocket expenses other than the monthly premium.
Keep in mind; the reason for health insurance coverage is to protect you against the unexpected costs of medical services. In the year 2002, twenty-five percent of the hospitalizations in the US were related to childbirth or pregnancy medical conditions with approximately 4 million births recorded yearly. In an analysis of claims data for billed provider charges submitted to the Maryland Health Insurance Plan (MHIP), the average bill for a normal vaginal childbirth exceeded $14,000 with a C-section at over $18, 000. The cost of the medical services rendered included, routine obstetric care, circumcision, anesthesia, hospital stay for mother and child, delivery method, and prenatal care.
How do you sort through the different maternity benefit offering?

Well, it requires research, luck or locating a licensed insurance professional knowledgeable with your family planning needs. Seek the guidance of a licensed insurance professional. An insurance agent/broker has the ability to sift through the number of choices available and recommend the appropriate one that best fits the planned event!

Martin J. et al.., " Births Final Data for 2001", National Vital Statistics Reports, December 18,2002.

Agency for Healthcare Research and Quality, "Hospitlaization in the United States, 2002L HCUP act Book No. 6." Health Care Cost and Utilization Project. Available online at: www.ahrq/data/hcup/factbk6/factbk6.pdf.

Pollitz, Karen, Mila Kufman, Alina Salganicoff, and Usha Ranji. Maternity Care and Comer Driven Health Plans. The Henry J. Kaiser Family Health Foundation. 2007. 13. 23 June 2008 .

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