Which is a better insurance plan when pregnant EPO or PPO?

Question

The EPO is with United Heath Care and the PPO is with Blue Cross Blue Shield.

The EPO is only in network (out of network can be used only if emergancy) pays 100% as long as you pay $15 co pay or $30 co pay for specialist. No refferals needed to go to specialist. $350 is required to pay if you have a baby but everything else is covered.

PPO is in network but you can go to out of network. In network pays 90% and you pay the other 10%. Deductible is $350 with an out of pocket maximum $1750 (individual) Out of network pays 70% and you pay 30% with a $700 deductible and a $3500 out of pocket maximum.

The PPO has family maximums out of pocket too which are $5250 (in network) and $10500 (out of network).

So which one is better? The EPO sounds better? But I dont really know anymore than the above on the two plans. Also what does "family" maximum mean? If I am the only one on the plan - am I individual until baby born? Then we are "family" - baby and I?? Thanks for the help!!

Answer 1

Either plan will do a good job for you. You did not mention price if they are similar in price and you don't mind having limited choices in the doctors then go with the EPO.

You need to find out how long the waiting period is to cover maternity. Some plans cover from day one (Kaiser) some plans have a six month waiting period before conception (Blue Cross). This means if you are currently pregnant and these are individual plans you will not be able to get coverage. Group plans will cover you even if you are pregnant.

No individual plan will extend coverage to someone that is currently pregnant.

With the deductibles and max out of pocket  there is a family maximum. Usually it is two times the deductible, this only helps you if you have more than 2 people on the family plan.