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Pregnancy loophole: Coverage surprises if you're on a parent's health insurance plan
Young women who are on their parents' health insurance plans should find out the policies' fine print before they get pregnant.
Although most job-based health plans must cover pregnancy-related care for employees and their spouses, federal law doesn't require the plans to extend maternity coverage to dependent children.
"This was a problem that existed before the Affordable Care Act," says Andrea Friedman, director of reproductive health programs for the National Partnership for Women & Families in Washington, D.C.
But more young women today may find themselves in this coverage loophole. Before the federal health care reform law was passed, many health plans kicked dependent children off their parents' plans when they turned 18. Now young adults up to age 26 can stay on a parent's health plan, regardless of whether they live away from home, are out of school or are married. The U.S. Department of Health and Human Services estimates 1.1 million young women have health insurance coverage as a result of the provision.
Spirit of the law
No one knows how many employer-sponsored plans do not extend pregnancy and maternity-care benefits to dependent children. "But we have heard it's somewhat common," says Judy Waxman, vice president and director of health and reproductive rights for the National Women's Law Center in Washington, D.C.
Waxman says the issue came to the center's attention in the last several months.
"Denying maternity coverage to women when providing coverage for everything else would seem to us to be sex discrimination," she says.
Friedman says, "It goes against the spirit and intent of the Affordable Care Act."
Starting in 2014, all individual and small group health plans must cover pregnancy and maternity-care services, one of 10 "essential benefits." Federal law will prohibit those plans from denying coverage or charging higher premiums for people with pre-existing conditions, including pregnancy.
Regardless of whether maternity is covered for a dependent child, don't expect to be able to add the grandchild to the health plan. Most employer-sponsored health plans don't extend coverage to grandchildren unless the employee is their legal guardian.
Today, it's impossible to buy a private individual health insurance plan with maternity coverage if you're already pregnant. And it's tough to find an affordable individual plan that covers pregnancy even if you're not pregnant. In a survey of individual health plans available to 30-year-old women in 2009, the National Women's Law Center found just 13 percent nationwide offered maternity benefits.
Some screenings might be covered
Most people who have maternity coverage get it through an employer-sponsored plan. The Pregnancy Discrimination Act of 1978 says that job-based health plans must cover pregnancy for the employee and dependent spouse the same way they cover other medical conditions. But the federal law, which applies to employers with at least 15 workers, does not require health plans to extend pregnancy and maternity benefits to dependent children.
However, even if you fall into this loophole, you still might get some prenatal services covered. Under the Affordable Care Act, new health plans, or those that have been changed substantially since the law was passed, must cover a wide range of preventive-care services without charging a deductible, copayment or co-insurance. Among those services are a variety of pregnancy-related screenings, such as testing for gestational diabetes, as well as breastfeeding supplies and support. The preventive-care requirement does not include an exception for dependent children.
Grandfathered plans -- those plans that existed before March 23, 2010, and have stayed essentially the same -- don't have to fully cover preventive care, but some do anyway. See Is your plan 'grandfathered'? You may be getting gypped.
Friedman says the National Partnership for Women & Families wants to hear from women who have been denied maternity benefits through their parents' health plans.
Although health care advocates are taking the issue seriously, they note that overall federal health care reform provides greater access to coverage overall starting in 2014.
"With so many problematic exclusions being removed, the few loopholes that exist will be that much more apparent, and there will be that much more pressure on insurers to make the good choice," Friedman says.
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