What Happened to California Health Insurance for Maternity?

Look at affordable individual health insurance plans available in California and you will notice that most of them exclude maternity coverage. Fortunately for mothers-to-be, there are five PPO, one HSA, and six HMO individual medical insurance plans that DO cover maternity benefits.  To find these plans when you get a quote on BenefitsCafe.com, just click the circle on the input page that says “only include plans with maternity.” Click here to go to the input page and compare benefits, the monthly premium, and also apply on line for medical plans with maternity coverage.

California Individual Health Insurance Plans that cover Maternity:

Blue Shield of California:

Shield Spectrum 5000 PPO. This plan has a $5,000 calendar year deductible and a $7,000 annual out-of-pocket (OOP) maximum. The plan will pay 70% of the cost of maternity care after the deductible has been met to in-network doctors and hospitals. (To learn more about deductibles and the OOP max, watch this video on key benefits:

Shield Spectrum 5500 PPO. This plan has a $5,500 calendar year deductible and a $7,500 annual out-of-pocket (OOP) maximum. For treatment by in-network doctors and hospitals, the plan will pay 65% of the cost of maternity care after the deductible has been met. The member pays 35% of the costs up to the OOP maximum.

Access + (plus) HMO Value. This HMO plan has a $2,000 deductible and a $4,000 annual out-of-pocket (OOP) maximum. After paying the deductible, the member pays 40 percent of the charges per admission up to the OOP maximum.

Access + (plus) HMO. Similar to the Value plan, this HMO plan has a $2,000 deductible but only a $3,000 annual out-of-pocket (OOP) maximum. After paying the deductible, the member pays only $250 per hospital admission up to the OOP maximum. Because of the richer benefits, this plan is costs more on a monthly basis.

Health Net of California:

HMO 40 NG. This HMO plan has a $1,500 deductible for in-hospital benefits and a $3,000 annual out-of-pocket (OOP) maximum. The monthly premium is relatively low for the HMO benefits of this plan.

Anthem Blue Cross of California:

Share 7500 PPO. This plan has a $7,500 calendar year deductible and a $7,500 annual out-of-pocket (OOP) maximum. There is generally no charge after the deductible for the cost of maternity care from in-network doctors and hospitals.

Share 5000 PPO. This plan has a $5,000 calendar year deductible and a $7,500 annual out-of-pocket (OOP) maximum. The plan will pay 70% of the cost of maternity care after the deductible has been met to in-network doctors and hospitals.

Lumenos HSA 5000/100% PPO. This plan is HSA compatible, which means that the cost of prescription medicine applies to the same deductible as medical care. The plan has a $5,000 calendar year deductible and annual out-of-pocket (OOP) maximum. There is generally no charge after the deductible for the cost of maternity care from in-network doctors and hospitals.

Share 3500 PPO. This plan has a $3,500 calendar year deductible and a $7,500 annual out-of-pocket (OOP) maximum. The plan will pay 70% of the cost of maternity care after the deductible has been met to in-network doctors and hospitals.

Select HMO. This HMO plan has NO deductible and only a $3,000 annual out-of-pocket (OOP) maximum.  The member pays only $250 per day in the hospital for up to four days.  This plan seems to have rich benefits and a relatively low monthly premium.

Saver HMO. This HMO plan has a $1,500 calendar year deductible and a $3,000 annual out-of-pocket (OOP) maximum.  The member pays 20 percent for maternity charges after the deductible.

Remember that you must apply for coverage BEFORE you are pregnant. Currently, all of the health insurance companies in California decline to cover women who are pregnant at the time they apply for coverage. On the other hand, these plans will cover the cost of maternity care as described above, when a woman is enrolled and later becomes pregnant.

The cost of having a baby can be huge. A normal delivery might cost about $5,000 including pre-natal and post delivery medical charges. The big risk is the enormous cost of care for pre-mature baby delivery, breech babies, cesarean sections, and all of the thousands of other complications that can arise from child birth. Any time a new born baby is in the neonatal intensive care section of a hospital, the medical expenses rise quickly, potentially $100,000 or more.

In addition to excluding maternity coverage, many California health insurance plans also limit coverage to a "single member only." The consequence of this is that if a woman covered by a health insurance plan without maternity coverage delivers a baby and pays for the delivery herself, the new born baby will not be covered under the mother's health insurance plan. Effectively, the insurance companies have precluded new born babies with health problems from enrolling. The plans listed above are not “single member only” plans so a mother would be able to add the child to the plan after delivery, regardless of medical condition.

While maternity coverage is excluded from most individual medical insurance plans in California, it is an included benefit in the twelve plans listed above.

(See benefit descriptions for complete plan information. Summary information as of August 29, 2011).

California Health Insurance | Contact | Privacy Statement | Sitemap | California Health Insurance Quotes