Maternity Coverage

For those unaware of maternity benefits and availability, let me explain.

With employer provided coverage, also known as group health insurance, maternity is an immediate benefit without restrictions to waiting periods.  There is no additional cost with limitations applying to infertility and fertilization.

When it comes to private coverage for individuals and families options are scarce and limited to one carrier, Blue Cross and Blue Shield of Illinois (BCBSIL) and includes civil unions.  Maternity is an optional benefit (additional premium) and imposes a 12 month waiting period before maternity services are covered.  Additional premium for benefit is paid until delivery.  This benefit can only be taken at time of application or at plan anniversary.  The only time premium is not required is when a male takes coverage to add a spouse later down the road.  This can begin elimination of the waiting period and once a spouse is added, additional premium will be required for the maternity benefit.

BCBSIL and all other carriers will cover complications of pregnancy.

All other options for maternity are with the 4 state plans ICHIP , IPXP, Moms and Babies and Illinois Healthy Women.

ICHIP has been around for a long time and is administered by BCBSIL and utilizes their network of providers.  Coverage is extremely expensive for health insurance and additional premium is required for maternity that imposes a 9 month waiting period.  To be eligible for coverage you must have been declined by a private carrier or have a plan that currently costs more than the state.

IPXP is from Obamacare (health reform) and utilizes the Healthlink network of providers.  This is an affordable option with maternity included at no additional cost and no waiting periods.  To be eligible for coverage you must go without health insurance for 6 months and have a qualifying pre-existing medical condition or have received an offer of coverage (not accepted) that placed exclusion riders on specific medical conditions.

Moms and Babies covers healthcare for women while they are pregnant and for 60 days after the baby is born. Moms & Babies covers both outpatient healthcare and inpatient hospital care, including delivery.  To be eligible you must be within a certain income range and will need to utilize a provider that accepts Medicaid. 

The last option, Illinois Healthy Women, is not health insurance but covers family planning (birth control) and certain services provided at the family planning visit, such as the physical exam, pap tests, lab tests for family planning, testing and medicine for sexually transmitted infections found during a family planning visit, and sterilization. Illinois Healthy Women also covers mammograms, multivitamins and folic acid if they are ordered by the doctor during the family planning visit.


For further information on your options please contact the shoppe.


Thanks,


-Shoppe