Individual Health Maternity Benefit in Texas

[NHB_MMA]

they use to but if I am correct they took mat out of the plan 2 to 3 years ago just for the fact people would jump on and off of it to have babies...

So even the state plan doesn't cover it? Wow!

I've wondered if maybe the solution could be a clause making a person stay with a health plan for a given amount of time following a pregnancy, so an insurance company has a chance to recoup a good amount of the maternity expenses?

 

[STIBROKER]

lots of insurance co's are looking at this as a health condition that the insured has control over...... if you want a baby....save for it like a car.......here is the exclusion from the risk pool....
http://www.txhealthpool.org/benefits.html

Charges for pregnancy or maternity care, including but not limited to normal deliveries, elective caesarean sections and elective abortions, except as provided for Complications of Pregnancy.

 

[somarco]

I certainly cannot speak for other states, but there are two provisions I thought were "standard" from state to state.

A mandate covering complications of preg, even if you do not have maternity coverage. In GA a carrier is permitted to opt out (rider) all maternity claims if the individual has had a previous complicated delivery.

A mandate allowing parents to add newborns, regardless of the health of the newborn and without regard to pre-ex, as long as the carrier is properly notified within 30 days of delivery.

Are there states where these provisions are not part of the law?

 

[NHB_MMA]

lots of insurance co's are looking at this as a health condition that the insured has control over...... if you want a baby....save for it like a car.......here is the exclusion from the risk pool....
http://www.txhealthpool.org/benefits.html

Charges for pregnancy or maternity care, including but not limited to normal deliveries, elective caesarean sections and elective abortions, except as provided for Complications of Pregnancy.

Oh, I understand it, from the company point of view. And, philosophically, I agree with it. People shouldn't be able to jump on a healthplan, pop a kid, then leave it.

However, I always (back in the day of selling individual health) felt uneasy about selling plans without maternity to single women or women that "didn't plan" on having another child. Even, if they understand the coverage, it's going to be a pissed off customer and they'll look back on it and say they should have stayed with BCBS, rather than some lesser known company.

 

[STIBROKER]

well thats why I always ask my clients about their plans for children....

 

[Dave020]

Oh, I understand it, from the company point of view. And, philosophically, I agree with it. People shouldn't be able to jump on a healthplan, pop a kid, then leave it.

However, I always (back in the day of selling individual health) felt uneasy about selling plans without maternity to single women or women that "didn't plan" on having another child. Even, if they understand the coverage, it's going to be a pissed off customer and they'll look back on it and say they should have stayed with BCBS, rather than some lesser known company.

In California, Both Blues allow the subscriber to migrate with no underwriting to a 5000 PPO plan to cover the maternity should she "get" pregnant while covered by a non-maternity plan. Kind of a safety net "just in case" LOL. So there is a level of protection in selling a woman who does not intend to become pregnant a non-maternity plan here.

CA MRMIP covers maternity and there is also the AIM program (with income restrictions) for pregnant women. Medi-Cal could also apply depending on the situation which would also cover maternity.

And California needs universal healthcare...why??

Dave

 

[Dave020]

...to cover the maternity should she "get" pregnant while covered by a non-maternity plan.
Dave

I'd like to rephrase that to "should she "become" pregnant...."



Dave

 

[J.R.]

In California, Both Blues allow the subscriber to migrate with no underwriting to a 5000 PPO plan to cover the maternity should she "get" pregnant while covered by a non-maternity plan. Kind of a safety net "just in case" LOL. So there is a level of protection in selling a woman who does not intend to become pregnant a non-maternity plan here.

CA MRMIP covers maternity and there is also the AIM program (with income restrictions) for pregnant women. Medi-Cal could also apply depending on the situation which would also cover maternity.

And California needs universal healthcare...why??

Dave

Because some people cannot afford a One Deductible Plan HSA after paying $500+ a month to lease their Mercedes or Beemer lease.

 

[Dave020]

LOL yes I guess in the end it all does come down to choices!

Dave

 

[STIBROKER]

http://www.insurance-forums.net/forum/showthread.php?p=9176#post9176Maternity is not what scares the company's...its the neonatal bills....