Maternity Benefits

[bluemarlin08]

Better make sure the client understands that Assurant maternity benefit and what happens if they have a c section, gotta meet both deductibles.

 

[somarco]

what happens if they have a c section, gotta meet both deductibles.

That happens with any carrier that writes a deductible maternity benefit. The exception would be a planned C-section.

 

[TXINSURANCE]

Better make sure the client understands that Assurant maternity benefit and what happens if they have a c section, gotta meet both deductibles.

Nice...

So C section doesn't fall under maternity benefits at all?

I can see if it was UNSCHEDULED C section one could argue this is a complication of maternity and therefore covered as a regular medical expense, and regular deductible.

There seems to be some thought in the agent community that C section is a complication of pregnancy , which in 99% of cases it is not and the claim will get declined based on my experience the line is drawn in the sand when the doctor schedules the procedure or not.

Either way in TX the lowest Assurant maternity deductible is $5000 - virtually impossible to sell. No one wants this, it is not a realistic product.

 

[InsuranceBenefitsGroup]

As Somarco mentioned in a prior post, maternity is more of a certain risk versus a pure risk. With this said, the cost to cover maternity on ind plans is going to be ridiculous and typically a wash.

 

[dmason]

In my experience with a c-section being covered as a complication of pregnancy here in Texas, it depends on how far along in the gestation the mother is. In other words, if the child has been carried to the end of the last trimester, a c-section becomes a complication of the delivery not the pregnancy. Complications of pregnancy are covered, but not complications of the delivery. Some lawyer sometime back successfully argued this and the court ruled in his clients (the insurance company) favor. Live and learn

 

[bluemarlin08]

Recently a client had Assurant 2500 max plan with a 2500 MD. Had a baby and had a c section, didn't remember our discussion regarding c sections. She was upset and threatening, discovered she hadn't disclosed on the app that she had a previous c section, that would have prompted Assurant to issue a exclusion rider. Explained to her she should let sleeping dogs lay.

 

[Guest]

Is there a maternity benefit out there that is worth paying the extra premium for? Every one I've seen (which isn't many) is just too expensive to mess with. What is your opinions?

Not in Texas

 

[somarco]

discovered she hadn't disclosed on the app that she had a previous c section,

How does one forget they had a C-section?

 

[dgoldenz]

Anthem (BC/BS) in VA is $71/month for maternity coverage, subject to the deductible chosen for the policy. Keycare Preferred copay plan has a $1500 or $2500 deductible option w/ no coinsurance after deductible. So after the first $1500, all expenses are covered. I called Anthem to confirm this and that is what they said, so I guess it's true.

 

[somarco]

Anthem (BC/BS) in VA is $71/month for maternity coverage, subject to the deductible chosen for the policy. Keycare Preferred copay plan has a $1500 or $2500 deductible option w/ no coinsurance after deductible. So after the first $1500, all expenses are covered. I called Anthem to confirm this and that is what they said, so I guess it's true.

Can't speak for VA, but they just rolled out their new (CA import) plans here about a month ago. The maternity benefit really blows. Hospital charges are covered in full xs of the $3000 copay. All other charges follow the underlying plan.