Many families are in search of affordable health insurance that will provide maternity or pregnancy benefits. Health carriers offer such plans, but they vary in the amount of coverage provided. Many insurers will not provide benefits to the insured for at least nine months.
As with all things insurance related, you must plan ahead. Occasionally, consumers are interested in maternity policies once they are already pregnant. They are disappointed to learn insurance cannot be purchased to cover a pregnant spouse – pregnancy is a preexisting condition. Insurers simply will not take on this risk. However, a health plan can be purchased for a healthy mother and child after delivery.
When is My Pregnancy Covered?
Generally, policies will provide benefits for maternity after the insurance has been in force for nine months, but some carriers offer plan with limited benefits that begin day one. However, if you were to purchase a plan with a nine month waiting period, your pregnancy would not be covered if the child was delivered before the nine month window had expired. Again, it is prudent to plan ahead and purchase a policy with a maternity rider some months before conception.
It might be helpful to look at this from the insurance provider’s point of view. Typically, when a couple desires and pays for a maternity plan, then they are likely to use it. The insurance company is relatively certain that a claim will come in the near future. Thus, they will build the cost into the premium for the insured (you) and mandate a waiting period. That being said, some companies are offering plans that are more attractive than others.
A Popular HSA Maternity Plan with a Reasonable Deductible
One insurance company offers a Health Savings Account (or HSA) with a maternity rider and a low $1,500 individual deductible. Once the deductible has been reached and the nine month waiting period has been satisfied, the plan would cover the balance of the pregnancy. In this example, you could fund the HSA account with at least the $1,500 and write that off against your income. The $1,500 could be withdrawn tax free to satisfy the deductible and then the policy benefits would kick in. Currently, this HSA plan is one of the more popular policies available.
Another popular plan has no waiting period and provides more benefits the longer the policy is held. The maternity rider will cover $2,000 toward a pregnancy in the first two years. During years three and four, the policy will pay up to $4,000 and years five and on the policy provides coverage up to $6,000.
Another option is to simply self insure for a pregnancy. Many consumers will purchase traditional health insurance or possibly an HSA qualified plan and save each month in order to cover maternity expenses.
How are Pregnancies Billed?
At this point, clients often ask about pre-natal care and doctor’s office visits. Fortunately, most Obstetricians do not charge as you go. Doctor’s visits, pre-natal care and delivery are all included as part of the pregnancy and usually subject to one, pre-determined charge. Thus, the final bill can be run through your insurance company (assuming you purchased a maternity rider) and then settled up.
When purchasing health insurance policies covering pregnancy, you must plan ahead. There are several options available, but you will get the most from your policy if you do your due diligence and purchase the policy ahead of time.
Request a Health Insurance Quote with Maternity
By: Adam Hyers
Posts Tagged ‘Hsa’
Health Insurance Plans Covering Maternity
January 27th, 2010Self Directed Group Health Insurance Plans
December 17th, 2009
Groups that currently have traditional health insurance can often save 30% to 40% with the HRA plan. The HRA, or Health Reimbursement Account has been around for a couple of years now, however the benefits are not widely known. It is a way to self fund some of the smaller expenses and reimburse the employee in the background so that as far as the employee is concerned, the plan looks, feels and works like his low deductible plan with co pays. Another option is the HSA or Health Savings Account plan. This type of plan allows for either the employer or the employee to put money into a tax free savings account that the employee has control of. That is why these are also known as self directed plans.
From the employee’s point of view these plans give a lot of freedom as to how his insurance money is spent and the employee can take this account with him when he moves to a different employer. The funds stay in the account until they are used or at the option of the employee, he can take the money out after age 65. At that point he or she avoids the 10% penalty but must pay taxes. One might consider leaving the funds in the MSA account even after retirement and use it for medical expenses not covered by insurance and therefore avoid paying the taxes. Groups of 25 full time employees or more have another option in addition to the above, a split-funded plan. The split-funded plan is one step below a self funded plan and should be considered as a stepping stone to a self funded plan. The plan works much like the HRA plan explained above except for two major points. If claims are less than expected, the savings is returned to the employer. The other advantage is the ongoing reports showing claims history. While personal treatment information is not revealed to the employer because of privacy laws, the reporting shows the amount of the claims and the person making the claims.
This information my help the company get a better handle on controlling medical costs and perhaps using some of the saved costs to promote wellness and fitness programs. With the information learned from a split-funded program, companies over 100 covered employees may want to venture into the land of the self funded plan. Unless the company has real deep pockets, insurance companies take on losses over a pre-determined amount. It is generally recognized that taking this on without the backing of an insurance company is too risky. Consider the fact the even insurance companies spread the risk by purchasing re-insurance from other insurance companies to protect themselves against an unforeseen man made or natural catastrophe.
Richard Evans
By: Richard R L Evans
Traditional Health Insurance Versus a Health Savings Account
November 13th, 2009
Consumers frequently inquire about the difference between these plans. Most understand the basics of traditional health insurance, but many do not understand the nuances of a Health Savings Account – or HSA.
What is a Health Savings Account?
The easiest way to explain the difference may be to clarify what health savings accounts are not. They are not health insurance plans. Rather, they operate much like savings accounts setup at a bank. And they are always coupled with a high deductible health insurance plan. That is to say, one could purchase high deductible health insurance coverage with or without a health savings account attached to the plan. A Health Savings Account is exactly that – an account established to save money for future health expenses.
The idea behind HSA’s is fairly straightforward. Owners deposit funds into their accounts to be used later for qualified health expenses. Funds can be used for a variety of expenses – including (but not limited to) visits to the doctor, prescriptions and/or meeting the deductible.
Advantages of HSA Compatible Plans
Generally, Health Savings Accounts will be less expensive than traditional insurance plans. The reason is simply that plan deductibles are higher. Therefore, the insurance company underwriting the plan will not have to immediately cover small, incidental claims. The owner would use funds from the HSA for many of the incidentals – like doctor visits, prescriptions, etc.
In addition, the attached savings account has significant tax advantages versus traditional health plans. Contributions into an HSA are tax deferred and the interest accumulates tax deferred – much like contributions to an IRA. However, when funds are withdrawn for qualified medical expenses, no taxes are due on those withdrawals. In this way, HSA’s provide tax advantages to the consumer twice – once when the money is deposited and again when it is withdrawn.
Who Should Consider a HSA Compatible Plan?
Healthy individuals who infrequently visit the doctor are good candidates. Individuals and families on a tight budget, but in need of affordable coverage could also consider a HSA plan. These consumers can pay smaller, minor health costs out of the HSA, but should they have a significant claim, the health insurance coupled with the plan is available once the deductible has been met.
Many employer sponsored group plans are already switching to HSA’s to lower their health care premium bills. The rising cost of health care is forcing many companies and small business groups to change insurance plans in order to save money. A HSA compatible plan can be a fair compromise for the employee and the employer. Some employer groups will make contributions to the HSA to encourage employees to make the change.
Who Should Consider Traditional Insurance?
Consumers who want lower deductibles and more in immediate benefits tend to purchase traditional plans. In the insurance industry, this concept is called “first dollar benefit”. These are benefits the consumer receives without having to meet a deductible or co-insurance provisions. Examples of first dollar benefits include annual physicals, visits to a specialist or non-specialist, OBGYN visits and prescription coverage. While newer HSA plans are offering more in first dollar benefits, usually traditional health insurance will provide the most in immediate benefits.
Traditional coverage can be more advantageous for families and/or middle aged or older consumers. These groups may be more likely to have several claims against their policies. They may desire more in immediate benefits. Additionally, they may simply have the resources available to afford more expensive policies.
In summary, there are many health insurance plans available to the individual, family and business group. Choosing the right plan will often times involve balancing cost with benefits. HSA compatible plans can be an affordable alternative to a traditional, lower deductible plan. Consumers, when working with an experienced independent agent, can usually find a suitable plan that fits their needs.
By: Adam Hyers
