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What You Need To Know About Pregnancy And Health insurance

Healthcare in America has shifted tremendously, but wading through the minutiae of insurance plans is not any less nerve-wracking. That goes double if you have a baby on the way. And the fact that so few plans currently cover wracked-nerves is pretty much an outrage. Thanks, Obamacare.

Since it’s probably too much to hope Helen in HR will be helpful for once in her cat-sweater-wearing life, here are some things you’ll want to roll around in your noggin before electing, or making any changes, to your insurance.

Pregnancy Coverage: They Gotta Have It
Strikingly, mandatory coverage for pregnant women only became the law of the land in the roll-out of the Affordable Care Act (ACA). This had not been the case prior to the ACA. However, some caveats exist. A plan could be grandfathered in if you enrolled prior to 2010. Those plans do not need to offer pregnancy coverage. Because obviously the idea of a pregnant grandfather is insane.

flickr / Leonard Nevarez

flickr / Leonard Nevarez

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Qualifying Event
Most health insurance plans allow for changes outside of the open enrollment period if there is a qualifying event. Getting pregnant is not a qualifying event, except in New York state.

If you’re planning on having a kid next year, be sure to make any changes in your plan during this year’s open enrollment period. If you’re going through a state insurance exchange, that period will begin in November, you know, when there isn’t anything else to worry about like pesky holidays and travel.

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It should be noted that having the kid is a qualifying event. So even if you changed coverage during the open enrollment period, you can do so again when your kid is born. The good news is that many plans allow 60 days to change coverage after the birth of a kid, but that coverage is actually backdated to the day of the delivery. So go ahead and feel like you’re beating the system with laziness.

flickr / Salim Virji

flickr / Salim Virji

A Note On Deductibles
This is one place where you’ll definitely want to talk to HR Helen. There are a couple of tricky situations you could get into with birth and deductibles, particularly if you got your lady knocked up in the spring, because she gave you fevah … Fevah!

In this case you’ll want to be prepared for a situation in which the mom or the kid could require medical care that would bridge deductible years. It’s a technical and nasty situation that could see you paying more out of pocket for the birth than you were expecting.

flickr / Ryan Hyde

flickr / Ryan Hyde

Questions. Questions.
There are tons of details to consider when changing or electing new coverage. Here are a few to have in mind:

  • Type Of Plan: Are you looking fee-for-service or managed care? Fee-for-service gives you freedom to seek care wherever, but also hit you with more in deductibles and copays (also lifetime payout caps). Managed care plans (HMOs for example) save you money by limiting your options to an in-network pool of doctors. More cost effective but less choice. Like shopping at Trader Joes.
  • Costs: Nail down what you’re going to be paying (and what you’d like to pay) in terms of deductibles, copays and premiums. Then, you can choose from a slate of plans coded by names of precious metals, because the insurance industry is getting rich!
  • Benefits: Do you get dental? Vision? Counseling services? A covered vasectomy when you’re, like, “Nope! Not going to do that again!”
  • Doctors: Your partner is going to have some doc or midwife  up to their elbows (almost literally) in her business. If there’s one she prefers, you should probably make sure they take your insurance.
  • Location: Where are you going to have the kid? Is care in that space covered? For home births, you may need to eat the cost of stuff like birth tubs.

The details can easily bog you down. If possible, get Helen in HR a new cat sweater so she’ll explain it to you nicely before you enroll. Or call your dad, whose preference for cat sweaters is not on record.