It has been more than 3 weeks since I posted anything in the website because I am so deep into CFP exam preparation which is coming up on Nov 19th and 20th. I literally don’t have time for anything and feel the 24hrs is really short period for a day. As some of you know, I have completed my CFP course and next milestone is to pass the exam. I been preparing for this exam since Aug and hope to pass the exam with GOD’s grace. I decided to finish this post which I started last month and take a break for the exam and come back later to update about my exam experience.
In the last related post about Maternity Insuarnce, I shared about our recent pregnancy experience with the cost associated with the process. We also saw some points on different ways to get a maternity coverage. In this post, we will see some important things to consider and finish up with the claim process which is really important to understand.
Important Things to Consider
How Maternity Insurance works?
You better understand how the Maternity insurance works so it will help you to keep up with benefits, bills and claims.
1. Get the Coverage first
As I mentioned in my early post, get the Maternity Insurance coverage first before getting pregnant. If you already have individual insurance, you should know that they don’t usually cover maternity/pregnancy. If they do, please confirm with your insurance provider about the benefits. May be there are few exceptions to some insurance carriers but 99% of the time they don’t cover it. In that case, you need to look for a coverage which can cover your pregnancy or at minimium share some expenses.
If you already pregnant and hope to get a coverage, sorry to say that you only have less than 1% chance in finding any insurance provider. If you haven’t got pregnant yet and thinking about it, WAIT!! You better get the coverage before you get pregnancy positive.
2. Select A Proper Plan
As per my research last year, there is not much options for Individual maternity coverage. You will have a choose a proper plan which suits your needs out of 2 or 3 out in the market. For example, Humana used to offer a plan in Texas which covers 50% of delivery cost with max of $5000 of you pregnancy and you have to pay the rest. The plan premium might cost you around $200/month and your coverage will be $5000. For an year with maternity expenses, you will get around $5000 off from you bill for the premium cost of $2400 for the year. It doesn’t cover anything else whether the delivery is complicated or normal. It is just an expense sharing mechanism.
On the other hand, Cigna(Assurant Health) plan which we bought last year is actually a good plan comes with your individual major medical coverage. So there is two parts to the coverage. One part which covers all major medical problems with a seperate deductible and out of pocket limit and the second part is totally for pregnancy and it has the deductible limit. We paid around $269/month for $5000 pregnancy deductible and $2000 major medical deductible with $2000 coinsurance max. It wasn’t bad compared to no coverage. It covers your normal delivery and complicated delivery will be covered under Major medical coverage. You can get the help of independent insurance agent like the one I used to find this insuarnce. My insurance wa Ruth in Houston, her website is instexas.com
3. Understanting Coverage Benefits
Like group health insurance, deductible insurance plan with maternity coverage covers both Major medical and maternity but have different deductible for major medical and maternity. They both works in tandem and you have to fullfil the deductibles seperately. If you going for your normal medical exam or physician visit, Major medical coverage kicks in and you pay the deductible for the visit as per the plan. If you visiting your gyny for Maternity/Pregnancy purpose, your maternity coverage of the policy kicks in and you pay the expenses related to the visit to satisfy your deductible for Maternity Coverage. Usually, lab work, prescription, gyny visit you will end up paying first to satisfy the deductible.
Normally with these type of plan, insurance company have a waiting period of atleast a month before getting pregnant. They just want make sure you are not pregnant at the time of pregnancy. So be careful with the timeline, we were so close and just about a month when my wife got pregnant. It is decided by your gynecologist during your first visit.
4. Choose Gynecologist
Next comes choosing the right gynecologist. If its your first pregnancy and you been asking your friends and family to refer a good gyny, thats a good start. But in order for the Maternity insurance plan to work, you better find a gynecologist who is under their provider network. Seeing an In-network gyne is really important in reducing your expense and getting insurance to cover most of cost as per the network agreements. If you are seeing out of network, it might not be covered 100%, check with your provider. You have to decide whether choosing a gyne who is referred by friends and not in network or gyne who is good but covered in the network. I would consider the second choice and try to get a list of gyne close to you and checking it out.
5. Select right In-Network Hospital
Today most of Hospitals take all major insurance carriers. So this won’t be an issue but similar to the gynecologist selection, you need to find the hospital where you want to have your baby accepts the insurance plan/network. Also find out from them how much will be estimated cost/expense for delivery both normal and complicated. Try to check with them whether they have payment arrangements if paid without insurance. Sometimes these hospitals are ready to work out an deal to avoid insurance carriers and give discount to the consumer directly.
Assumption is dangerious and risky. So it is important to select the right plan, choosing the right gyne and the hospital which is covered by the maternity insurance carrier. Otherwise it will too late once you become pregnant and you will be wasting your money and end up losing your savings. These are five important items which needs to be considered and understood properly while taking your individual maternity/pregnancy insurance coverage.
I thought of completing the Maternity Insurance series by posting everything in this post but it’s already too long. So I decided to cover the rest of topics about Claims and Appeals process in the next post after exam. I will see you guys after Nov 20th, wish me some luck.
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