If you’re planning a family, expect a lot of changes to your healthcare coverage needs.
While health insurance is important to have in the case of a medical emergency or an on-going illness, it’s also a vital part of welcoming a new baby to the family. Sure, prenatal visits, hospital stays, and outpatient services for the mother and baby are all costs included in a routine pregnancy and delivery; however, birth complications and health issues with the baby increase the cost of healthcare. When planning a family, it’s important to understand exactly how your health insurance policy handles maternal and child health.
Start by reviewing your level of financial obligation (deductibles, copays, and coinsurance) under your current health plan and other options available to you. if you’re considering changing health plans anyway, the birth of your baby might be the right time to do so.
When planning a family, here are six questions you should consider when deciding on new health insurance coverage.
1. Am I able to add my child to my current coverage? If so, how much will it cost?
Though you might be having your baby outside of your insurance policy’s enrollment period, the birth of a child is considered a qualifying life event. A qualifying life event allows you to be eligible for a Special Enrollment Period due to a change in situation, such as having a baby. Due to this qualifying life event, you are able to either:
- Make changes to your current plan, such as adding the baby as a dependent;
- Change to a different plan offered by your insurance provider; or
- Purchase a new policy if you do not already have coverage.
Depending on your policy, you will have a period of 60 days after the event to make a change to your plan. The specific length of time for your plan can be found in the Summary Plan Document (SPD), which can be supplied by your insurance provider.
The cost of adding a child will depend on the health insurance policy and number of members already on the plan. Insurance plans have different types of tiers which determine the monthly premium for the plan. For example, if you are moving from an individual plan to a family plan, your monthly premium will go up.
In addition to the premium, it’s important to consider the change in deductibles, copayments and coinsurance when moving from an individual plan to a family plan. Be sure to review all of these factors if you are considering changing plans when the baby arrives.
2. What is my policy’s level of maternity coverage?
Coverage for pregnancy, labor, delivery and childbirth are essential health benefits, meaning a health insurance plan must cover them. This became mandatory under the Affordable Care Act in 2014. Coverage includes hospital charges for the mother and baby, routine obstetric care, anesthesia, lab charges, prescriptions and radiology.
The only potential way maternity could not be covered is if your health insurance plan is Grandfathered. Grandfathered plans are plans that have been in existence since March 23, 2010 and have not been significantly changed.
3. Will my policy cover my pregnant partner if we are unmarried?
Health insurance plans typically do not offer coverage to unmarried partners. A caveat to this would be if you and your partner live together and qualify as domestic partners. A domestic partnership is two people of the same or opposite sex who live together and share a domestic life.
Plans can choose whether or not coverage can be extended to domestic partners. Check your Summary Plan Document to find your plan’s policy on domestic partner coverage.
4. Is dental coverage provided?
Regardless of who you purchase your health insurance plan from, health insurance plans are required to provide pediatric dental coverage. Since 2015, pediatric dental plans have had a maximum out-of-pocket cost of $350 for a single child or $700 per family that has more than one child.
Keep in mind, though, that dental coverage provided under ACA-compliant health insurance plans doesn’t include what might be standardly thought of as preventative dental care. Dental coverage for children includes fluoride treatment for children lacking access to water with fluoride. It also includes oral health risk assessments for dental conditions specific to young children. Cleanings and X-rays are not covered under medical plans and require a standalone pediatric dental plan. Dental coverage for children is extremely important, especially since dental procedures can be quite costly.
5. When does coverage for the newborn child begin?
Start by notifying your health insurance provider that your baby has been born and needs to be added to your plan. A carrier will not automatically assume the baby should be added based on the fact you have had pregnancy-related claims over the last nine months.
Depending on your health plan, you will need to notify the carrier within 30 to 60 days of the baby being born. Most plans will cover the baby back to the date of birth.
6. Should I move to a plan with lower deductibles and copayments?
The answer to this question will vary from family to family. To decide, start by comparing the plans available to you through an employer or the Marketplace for your state. Evaluate your monthly premium in comparison to deductible, copayments, and coinsurance amounts due. Also consider the health status of everyone on the plan. If the newborn or anyone else on the plan requires ongoing medical procedures or high-cost prescriptions, a plan with lower deductibles may be more cost-effective.
The views expressed here are those of the author and do not necessarily represent or reflect the views of Healthcare, Inc. and HealthCare.com.
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