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What You Need to Know About Maternity Insurance Coverage

Pregnancy marks an exciting time in a woman’s life. It also means spending more time in your doctor’s office. However, individual health insurance plans have not always provided coverage for expectant mothers. Prior to 2014, pregnancy benefits were only covered by about 12% of individual health insurance policies. This meant that once a woman became pregnant, she would pay for medical services out of pocket or have to add a special rider to her insurance plan.

In addition, pregnancy was considered a preexisting condition, making things even more difficult for expectant mothers. Most couldn’t find health insurance coverage to cover maternity benefits or they would have to pay significantly higher rates if they did.

In 2014, the Affordable Care Act mandated all health insurance plans must include coverage for pregnancy, labor, delivery, and newborn baby care.

Services Covered by Maternity Insurance

Now that maternity coverage is one of the 10 essential health benefits offered to families, individuals, and small groups under ACA, these are the services covered by health insurance plans:

  • Outpatient care, such as prenatal and postnatal doctor visits, lab studies, gestational diabetes screenings, medications, and other necessary outpatient services.
  • Inpatient care, such as physician fees, hospitalization, and other required inpatient services.
  • Newborn care.
  • Lactation support and necessary breast pump rental.

How to Enroll for Maternity Benefits

If you are not covered under a group health plan, Open Enrollment for health insurance plans starts November 1st and ends December 15th every year. During this period you can enroll in a new health insurance policy through your state’s Marketplace or make changes to an existing plan you already have.

If you miss the open enrollment window, not to worry, you may be eligible for a Special Enrollment Period due to certain life events, such as:

  • A new marriage.
  • A recent divorce.
  • The loss of a group health plan due to termination of employment.
  • An adoption or birth of a new baby (pregnancy is not considered a qualifying life event.)

Understanding health insurance can be confusing. To learn more about maternity insurance and what it covers, contact the professionals at at (855) 401-8383. Our licensed experts will be happy to answer any questions you have.

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