Maternity Coverage

They consider it a preexisting condition. Email your congressman and tell them you want the insurance companies to stop interfering with your health options.

That is the policy with most health insurances, you have to wait one year before you get pregnant. Can't wait 4m into the plan, after one year, then you can get pregnant. If you want to get pregnant and had a successful hospital birth, you can try a homebirth, which is rising in Chicago and New York.

I went through this after I left my employer and looking for coverage and they all said the same thing, but ended up with my husband's crappy HMO plan...

I hope this helps!

J. W. MPH
Maternal and Child Health Educator
Chicago Examiner Family Health Expert
http://www.examiner.com/x-7158-Chicago-Family-Health-Exam...

EDIT: OK, I now see your further explaination. That makes a whole lot more sense to me as to why you would be finding insurance and so on. Honestly, I don't know of any insurance companies that would cover maternity within the firt year although you may be able to negotiate a ryder to do so but I'm sure you can expect a heafy cost because of it. Also, check with supplemental insurance companies to see if they offer such coverage.

Also, to answer your question about the 4 months scenario - as a general rule of thumb they would cover anything after the 1 year mark. This will include the birth and any additional prenatal care you may be needing at that time. However, any care beforehand will not be covered, and of course the birth should it happen early. Plus someone mentioned pre-existing condition. Many companies differ on this subject that's why I said general rule of thumb. Many companies will follow what I mentioned but some will not so you will want to confirm. But so you know, it is possible.

I am a laid off HR manager/operations director so if you have any further questions, please feel free to email me personally.

You're reading it correctly. Insurance does not have to cover it if their policy is written that way. I think the maternity coverage you're thinking of is the leave you get from the employer covered by FMLA. Yes, it is a law that companies have to offer FMLA but it is up to the company to decide if it's paid or unpaid, both are legal and completely up to the employer. BUT because you work for such a small company, they technically don't have to offer FMLA or follow the substandards of it. This is a loop hole with the program. It only applies to companies who employ 15 or more employees. So techically they don't have to give you any kind of a leave and there's nothing you can do about it. BUT once it's written in their company paperwork saying they do offer it, they have to. They can't change their minds case-to-case. They have to be consistent.

It stinks and there are a lot of small companies that are cutting their leaves out right now because of the economy. Something that really stinks more, is that if the company employs 13 or less they also don't have to follow EOE (equal opportunity employment) standards. Meaning that if you get pregnant or you get sick or, and I'm not kidding, you change the color or your hair, they can fire you because you are no longer convenient to the company. And there's also nothing you can do about it. These are government loop holes they have established to be in favor of small companies so they can have more leniency because it may be harder for them to find and keep employees that maintain the function of the business. I am telling you this because working for small companies has a lot of pros but things like this can be a huge problem if you don't know about them ahead of time. Just wanted to make you aware.

You're talking about Group coverage, but I think what you are really looking at are individual plans for the 4 employees. That isn't the same as being part of a Group like you would be through a big company health care package. What you are reading is correct. I've been through this! I actually had to wait until I went back to work full time and had employer health insurance again to have a second child because even after waiting the year we just couldn't afford the maternity coverage on our individual health plan. I think it's going to cost you A LOT more than $250/month for maternity coverage, so be prepared to pay up if that's what you really want.

My husband and I have a good friend who is a health insurance agent and he's awesome!
His name is Jordan Wishner. He's local. I think his office is on Belmont.
____@____.com

I'm attaching his email. He can definitely help you shop around for the best plan for your group of employees! He works with more than one insurance company and can give you all the info and compare the benefits & prices... I think shopping for insurance on your own is very confusing. He was a huge help for us. We've changed plans several times over the past few years, and he's been a big help with each change.
Good luck!

That's why we paid almost $900/month for Cobra some years ago instead of buying an independent plan. As far as I know, it's perfectly legal for them to do that.

Write your representatives. Support universal, single-payer health care!

ETA - I just remembered that friends of ours who are self-employed decided to go without maternity coverage. They negotiated everything about the pregnancy up front with the hospital and midwife and arranged discounts and payment plans. The cost was not cheap, but it was not unreasonable. She had a C-section but I believe that part was covered under her policy (? I could be wrong about that) and once the baby is born, he or she has their own policy so they would be covered for any NICU care or problems under that. So that is another possibility that we weren't aware of when we were in that position ourselves.