Pregnancy and Insurance: Are You Covered?

Sometimes a company goes through an independent agent for their insurance needs. Renee Guariglia, the executive vice president of Falcon Associates, Inc., an employee benefits company, says that while many employees go to human resources or directly to the insurance carriers for insurance questions, if the company uses an independent agent that is the person to contact.

"As their agent, our job is to know the benefits inside and out," Guariglia says. "An HR person has so many other tasks that they are responsible for—knowing insurance benefits should not be one of them. If the HR person misspeaks, then there is the additional liability for the misinformation. So don't be afraid to ask your agent or broker questions on your health benefits. That is what they are there for."

3 Things You Need to Know

The following tips will help pregnant women navigate the ins and outs regarding insurance coverage:

1. Don't assume that once your baby is born that she will be automatically added to your health insurance. You must complete an application to add your baby to your plan within 30 days of the birth and return it to your HR person as soon as possible for processing. Guariglia recommends that the employee bring the application home early and start completing as much as possible beforehand. Then once the baby is born, they only need to insert the baby's information and can immediately return to their HR person for processing.
2. If you are covered under an HMO plan, you will want to confirm the office visit and hospital co-payment amounts. If you are covered under a PPO plan, you will want to confirm the deductible, the office co-payment and the out-of-pocket maximum amount. With regard to office visit co-payments, you may also want to confirm whether there is one co-payment for each office visit or one co-payment for the entire pregnancy.
3. According to Olson, there is an important federal law that protects women from being shooed out of the hospital too soon after delivery. In general, group health plans may not restrict benefits for a hospital stay for childbirth for the mother or newborn child to less than 48 hours following a normal vaginal delivery, or less than 96 hours following a Cesarean section. If a mother wants to return home early, she may do so, but insurance benefits cannot be restricted and force her (or the baby) to leave the hospital sooner than 48/96 hours after delivery.

4 Questions to Ask

1. Is pre-authorization required for any care including ultrasounds, hospital stay, or additional testing outside of normal pregnancy care?
2. Does the plan limit the number of inpatient hospital days for regular delivery? C-section?
3. If there are complications, who needs to contact the insurance company?
4. Does the plan limit the number of days my baby can remain in the hospital?

Navigating the confusing waters of insurance coverage while pregnant doesn't have to take away from the joy of your impending birth. Just remember to be vigilant, be questioning, and be informed.