Health Insurance and Pregnancy: Coverage for You and Your New Baby

If you are a new parent or expectant mother, good health insurance coverage is more important than ever. You will depend on your health insurance for everything from prenatal and maternity care to pediatric visits and immunizations for your baby. To avoid surprise medical bills, it's important to learn the terms of your health insurance coverage right now. You'll also need to take steps to maintain your health insurance coverage if you lose or quit your job.

Questions to Ask About Prenatal and Maternity Care Coverage

Before you set up your first obstetrician or midwife appointment, it's smart to figure out what your health insurance will (and won't) cover. Get the answers to the following questions from your company's benefits department or through your health insurance plan's customer service hotline:

• Does the plan cover prenatal and maternity care? If you work for an employer with 15 or more employees, federal law requires that your plan cover your pregnancy-related medical bills.
• Will you need preauthorization for any of your prenatal or maternity care?
• Must you contact the health insurance company when you are admitted to the hospital for labor and delivery? Some health plans will penalize you financially if you don't call shortly after your admission.
• What are the plan's rules regarding in-network and out-of-network health care providers? What about hospitals? If the plan provides greater coverage for in-network providers and hospitals, ask for a directory of in-network services in your area.
• Will you need a referral from your primary care doctor to see an obstetrician? Although most plans don't require this, they might require a referral for a specialist in the event of complications.
• What coverage does the plan provide for prenatal tests such as ultrasounds and amniocentesis procedures?
• How much inpatient hospital time will the plan cover after delivery? Will the plan cover an extended stay if medically necessary?
• Does the plan have an annual reimbursement limit? If so, it will not pay for health care costs that exceed that limit.

If you want to use a certified nurse midwife or deliver your baby in a birth center or at home, find out what coverage your plan provides in these situations. Most plans cover a certified nurse midwife, and some will pay for a delivery at selected birth centers. Very few insurance plans cover home births, however.

Questions to Ask About Coverage for Your Baby

With the arrival of a new baby comes the arrival of medical bills from the pediatrician, the nursery, and (in some cases) the neonatal intensive care unit (NICU). In fact, a bill from the hospital may be the first piece of mail your baby receives. Here are some questions to ask to cover your insurance bases before your baby arrives:

• What is the procedure for adding your new baby to your plan?
• Will the plan cover your newborn's nursery stay? Remember that your newborn's hospital bill will be separate from your own. Typically, a health insurance plan will provide coverage only if you enroll your child for dependent benefits within 30 days of birth.
• Will the plan cover the costs of a NICU stay for your newborn?
• What are the plan's rules regarding in-network and out-of-network pediatricians? If the plan provides greater coverage for in-network pediatricians, ask for a directory of in-network doctors in your area.
• Does the plan cover well-child care, such as your baby's first set of pediatrician appointments and vaccinations?

If You Lose or Quit Your Job

Life is rarely predictable, especially when it comes to work. If you happen to lose your job or change jobs during your pregnancy or soon after your baby is born, you'll need to pay careful attention to health insurance issues. Otherwise, you could be left uninsured at one of the most important (and expensive) times in your life.

When you change jobs, you usually give up health insurance coverage through your former employer and sign up for health benefits with your new employer. But expectant parents need to be especially careful when making job-related health insurance changes. This is because some employers impose a waiting period of a few months before you are eligible for health insurance coverage. If your baby is born while you are waiting for your benefits to kick in, you'll be responsible for the bills.

Even if you are immediately eligible for health insurance benefits through your new employer, look before you leap: The terms of your new health insurance plan could be quite different than those of your old plan, and you may be forced to switch physicians at a very inconvenient time -- midway through your pregnancy, for example. You also need to watch out for exclusions for preexisting conditions --your pregnancy could qualify.

The smartest option is often to continue health insurance coverage under your old employer's plan, at least until you deliver your baby. Thanks to a federal law called COBRA, you can keep your health insurance coverage for up to 36 months after you leave your job if you work for an employer with 20 or more employees. (If you work for a smaller employer, your state might have a law similar to COBRA that can help you.)

COBRA coverage will cost you quite a bit more than you're used to paying, however: usually your full premium, plus up to 2% for administrative costs. But the added expense will be well worth it if your new employer imposes a waiting period for health benefits or if the new plan is more restrictive than your current one.

If you happen to lose your job during your pregnancy, COBRA and similar state laws can be a lifesaver. Unless you can immediately sign up for health insurance coverage through your spouse or partner's employer-sponsored plan, it's very important that you sign up for continuation of your current health insurance benefits through COBRA or a similar state law. Without this coverage, you'll have to pay out of pocket for your prenatal and maternity care, and for your child's health bills.

For More Information

You can find a complete discussion of common health insurance issues for new and expectant parents in Parent Savvy: Straight Answers to Your Family's Financial, Legal & Practical Questions, by Nihara Choudhri (Nolo).