Do any individual or family insurance plans offer decent maternity coverage?
Medical insurance doesn’t work — it can’t work, really, if you think about it — if you can plan to incur covered care which exceed your premiums. That’s why individual policies will always have hefty maternity waiting periods and exclusions which assure that you will effectively pre-pay. And it’s not like group coverage is any different — it’s just that with more employees to spread it around it doesn’t feel like the employer is prepaying maternity, but believe me, it is. Coverage of maternity is a big reason why even large employers can pay over $12,000 a year per employee for coverage. Does this mean that you shouldn’t take on one of those expensive and wait period plans? NO! This is because those plans will still be real insurance for the unexpected component of maternity costs, if complications could arise. In other words, you’ll prepay the $6,000 or so that an average uncomplicated pregnancy costs, but you will also pay another $6,000 in actual insurance premiums against the $1
I’m not a benefits administrator, just a member, so I’m not in a position to evaluate whether this plan is available for you, but following is my benefits summary for maternity care through Oxford Health: Type of Service – General: BASIC SERIVCES: MATERNITY CARE Oxford covers this service when medically necessary and appropriate. This benefit has no maximum payment or visit limit. Type of Service – Inplan: Care rendered by an Oxford Participating Provider is covered at 100% after initial visit. Initial visit only is subject to the members PCP copayment. Services received may be accessed directly from the oxford participating specialist without a referral from the primary care physician. Type of Service – Outplan: Care rendered from a non participating provider is covered subject to the deductible, coinsurance and usual and customary allowance. Precertification is required. If precertification is not obtained, services are subject to a penalty of 50% of the cost.
In all reality, the reason why you won’t find many policies that have ‘decent’ maternity coverage is to prevent people from starting the insurance, having their baby and then ditching it. The insurance doesn’t work if you only get it when you need it. Most group policies are subject to governmental regulations regarding preexisting conditions. This includes requiring you to have a prior carrier for at least a year with no longer than a 63 day gap as well. But on group policies, maternity is not a preexisting condition. These regulations do not apply for individual or administrative service policies. You may be able to get a group policy as your corporation and be able to enjoy the benefit of maternity not being preexisting but the trade off is that group insurance is astronomically expensive. Expensive unless you have a pretty high deductible, like an HDHP with an HSA plan. Historically group policies are cheaper for employees because of the company subsidizing the insurance. You may p
