Pregnancy Coverage is an essential health benefit!
Maternity care and childbirth coverage is covered by all health insurance plans offered to individuals, families, and small groups. This is true even if your pregnancy begins before your coverage takes effect.
All plans must include coverage for:
- Outpatient services, such as prenatal and postnatal doctor visits, gestational diabetes screenings, lab studies, medications, etc.
- Inpatient services, such as hospitalization, physician fees, etc.
- Newborn baby care
- Lactation counseling and breast pump rental
Plans vary on how much they cover for each of these services, but each Summary of Benefits and Coverage (SBC) is required to provide information on pregnancy and gestational coverage. All SBCs will include a cost estimate example for costs associated with having a baby in the last few pages of the SBC.
If you already have healthcare coverage when your baby is born, you have 2 options:
- Keep your current plan and add your child to your coverage plan.
- Opt for a different plan with better pregnancy coverage.
Picking a Plan Tip!
A birth or an “addition of a new dependent” counts as a qualifying event and triggers the 60-day window during which an individual or family can apply for coverage or change plans. This is important when reviewing plans, as you may want to think about selecting one with better pregnancy coverage now, and opt for a cheaper plan once the baby is born!
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- It’s important to remember that the pregnancy itself is not a qualifying event and will not act as a trigger for Special Enrollment. **EXCEPT for NY (see below)** Most insurance companies will give applicants an effective date of the day the child was born. This means that any postnatal care will be covered (even retroactively), and the child will be covered from birth until the policy expires or is cancelled.
- When picking your plan, it is important to consider whether you have a preferred physician or specific pregnancy services that you would like to get coverage for.
- Once you’ve chosen a plan, be sure to verify with your physician.
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