Does maternity rider for individual health care plans and group plans work differently?

Question

Say if the waiting period is 10 months and you conceive 4 months from the start of maternity rider. Does this mean that the insurance company will foot the bill for delivery but not the pre-natal care , ultrasounds etc ? If you are a part of an employer's group plan with maternity benefits/maternity rider, does this waiting period work differently?

Answer 1

Actually, with a 10 month waiting period I don't think you'll have any coverage relating to the pregnancy.  Delivery may occur after the 10 month waiting period but the condition requiring the care (the impregnation) occured prior to the end of the waiting period.  I may be wrong however, so I would recommend that you check with the insurance carrier.

Answer 2

The group and indivudal part has nothing to do with it.  And it'll work differently plan to plan.  It could be that it'll start paying for that preganancy after the 10 months or they could exclude the whole pregnancy if you conceive during the 10 months.

Read it and find out.

Answer 3

Hi there,

Maternity riders work the same in group plans as they do in Individual plans.  

A waiting period is for conditions that you may/may not have had at the time you applied for the policy.  On and individual policy, you could not have been approved if you had been pregnant at the time your applied.  If you get pregnant 4 months from the start of the plan, you should be fine.  

If your plan covers maternity, it should cover all normal pre-natal and post-natal care as well as the delivery.  On a PPO plan, physicians typically agree to "global billing", which means that they submit one large bill after the delivery for all services that they provide.  

Group benefits should work about the same, with the only difference being that there would not be the same waiting period.

I hope that answers your questions.  Good luck!

Kathy K

www.premiumwatchdog.com

Answer 4

yes in group plans they treat maternity as any other illness but they may consider this pre-existing any way

Answer 5

It is a federal mandate that pregnancy cannot be considered as a pre-existing condition. It is under the HIPAA laws and more information can be found here: http://www.dol.gov/ebsa/faqs/faq_consume...

Individual health insurance may be different between plans. Some plans word the maternity waiting period as X number of months for conception while others word it as X number of months for delivery.