Picking the right insurance plan when pregnant or expecting

Pregnancy Coverage Is an Essential Health Benefit!

All health insurance plans offered to individuals, families, and small groups include maternity care and childbirth coverage. This applies even if your pregnancy begins before your coverage takes effect.

Every plan must include coverage for:

• Outpatient services, including prenatal and postnatal doctor visits, gestational diabetes screenings, lab work, medications, and more.
• Inpatient services, including hospital stays and physician fees.
• Newborn care
• Lactation counseling and breast pump rentals

Plans differ in how much they cover for each service, but every Summary of Benefits and Coverage (SBC) must include information about pregnancy and maternity coverage. In the last few pages, each SBC also includes an example of estimated costs for having a baby.

If you already have health coverage when your baby is born, you have two options:

1. Keep your current plan and add your child to it.
2. Choose a different plan with better pregnancy coverage.

Tip for Choosing a Plan!

A birth, or the addition of a new dependent, is a qualifying event. It starts a 60-day window during which you or your family can apply for coverage or change plans. Keep this in mind when comparing plans: you may want to choose one with better pregnancy coverage now and switch to a less expensive plan after your baby is born.

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Note:

• In most states, pregnancy itself is not a qualifying event and does not trigger a Special Enrollment Period. Most insurance companies will give applicants an effective date of the day their child was born. This means postnatal care will be covered, even retroactively, and the child will be covered from birth until the policy expires or is canceled.
• Pregnancy is considered a qualifying life event in the following states:
  • New York
  • Connecticut
  • District of Columbia
  • New Jersey
  • Maryland
  • Maine
• When choosing your plan, consider whether you have a preferred physician or specific pregnancy services you want covered.
• After choosing a plan, be sure to confirm the details with your physician.