Congratulations! You and your partner just found out you’re expecting. You now have nine months to pick out a name, decorate the nursery (with a theme of course) and everything else that comes along with expecting a baby.
But along with all of that, there's something else you must consider: developing the best health insurance plan for your new family. As soon-to-be proud parents, you’ll want to know what doctors and facilities are considered “in network,” maternity costs and expenses to expect, the importance of short-term disability and more.
Here are some essential insurance moves and tips for you to consider before the big day arrives:
1. Understand the importance of in-network care for maternity coverage.
Check that your preferred OB/GYN is in network with your health plan, and make sure your hospital of choice and NICU unit all participate in your network. Those steps will help drastically minimize your out-of-pocket maternity costs. You don't want to receive an unexpected bill after the baby arrives that was treated as an out-of-network procedure when it could have been solved by going to an in-network provider from the start. Do your homework.
2. Study and become familiar with your SBC.
The best way to estimate and understand your maternity expenses is to look at your SBC, aka your "summary of benefits and coverage." Your employer is required to provide you with one each year. Toward the end of your SBC, there's a section about maternity that lists examples of what your plan will cover.
3. Know how you'll be billed.
We get a lot of questions about how the deductible works for maternity visits and expenses over the course of that year. Find out how your doctor takes deductible payments. When you go in for your first visit, they will start to collect your deductible as you go, so that by the time you have the baby, you most likely will have already met your deductible.
Plan ahead by getting a detailed list of expenses for your delivery and hospital stay months ahead of your due date. Because not all health plans are the same, compare your health plan to your partner’s and ask questions of each of your employers to see whose coverage might offer the best benefits for your baby.
4. Sign up for short-term disability now.
The goal is to sign up for short-term disability before you have a baby. Couples who are just beginning to consider starting a family should go ahead and sign up for short-term disability at the next open enrollment date.
If you are currently pregnant and enrolled in short-term disability, fill out and file the claims paperwork now. That way, when you have the baby, all the tedious paperwork is done and you can focus on taking care of your little one while receiving your disability benefits.
5. Use your insurance to save.
Call your insurance company or ask your HR department about how much your insurance will pay towards breast pumps. Your HSA/FSA allows you to save pre-tax dollars that can go toward covering the costs of ultrasounds, insurance premiums, breast pumps and supplies, birth classes and more. Try to open an HSA/FSA before you become pregnant and contribute as much money into it as you can to help pay for out-of-pocket medical expenses.
6. Know what's covered.
Certain blood tests and ultrasounds may or may not be covered. If you are under 35 years old, your plan will most likely cover one ultrasound at 18 weeks. If you are over 35 years old, your plan will most likely cover two ultrasounds (the initial ultrasound and high-risk ultrasound).
Know that 3D and 4D ultrasounds, genetic testing and early gender testing are most likely not covered. If you are considered a high-risk pregnancy, your provider may be able to help get certain services covered due to the nature of your pregnancy. Great communication with your provider is key.
Caty Demmig is the marketing and design director for The Hatcher Agency.