Congratulations! You’ve decided to start a family. Up until now, your health insurance has probably been adequate, paying for routine doctor visits and prescription drugs. But now that you’re facing a lifestyle change, you must make sure that your health insurance policy will keep up with those changing needs.
After you bring your baby home
How easy will it be to get emergency care under your plan’s rules? Babies are susceptible to illnesses and injuries. You don’t want to have to wait for prior approval or drive past two hospitals while rushing your sick newborn to an approved medical facility.
Will the plan pay for transportation costs to the nearest facility to treat any special conditions? If so, is there a maximum amount?
Does the policy have a maximum amount it will pay for well-child care? Well-child care usually includes physical examinations, laboratory tests, developmental assessment, immunizations, and guidance necessary to monitor the normal growth and development of your child. How many years will it pay?
What if your adopted baby is born with medical problems you didn’t expect? Will the policy cover pre-existing conditions if you’re adopting an older child? Does the plan offer home visits for new mothers?
Understand your out-of-pocket expenses
Many policies have a family deductible, which is the maximum amount that the family as a group must pay before the coverage begins. Instead of multiplying the individual deductible by the number of family members, the family deductible is often two or three times the individual deductible, regardless of how many family members are covered. The same is true of your coinsurance cap.
Review your co-payments. With a new baby, you will be making more trips to the doctor and buying more prescription medicines. It might be worthwhile to lower your deductible and co-payment. Your insurance premiums will be higher, but your benefits will be greater. Do a comparison to see what will work best for you.
Maximum lifetime benefits
The Affordable Care Act prohibits individual and group health plans from placing lifetime limits on the dollar value of coverage, rescinding coverage except in cases of fraud, and from denying coverage based on pre-existing medical conditions. Also, plans may not place annual limits on coverage, except in the case of grandfathered plans.
Read your policy carefully and make sure you have the coverage you need. If you have questions, meet with an insurance professional. Understand how your policy works–what’s covered and what isn’t.