Women Employer Health Plans Pay A Big Price pregnancy

 

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Copyright 2009 Inc.All rights reserved Marketwatch.com
MarketWatch

11 March 2009 Wednesday 6:44 PM EST

SECTION: PERSONAL FINANCE; Life & Money

LENGTH: 1456 words


TITLE: Women without employer health plans to pay a grand prize of pregnancy

Signature: Anya Martin.

Anya Martin is a freelance writer based in Decatur, Georgia



DECATUR, Ga. (MarketWatch) - The babies are generally regarded as a bundle of joy, but if you are a woman depends on a system of individual health insurance in May, you will find a set of requirements for maintaining coverage motherhood.

With soaring unemployment rates and more Americans lose themselves to find health insurance, women are often surprised to learn that motherhood in the political coverage costs more, may require waiting period and, in some States May be difficult to find at all.

When Fiona Leonard, an Atlanta, Ga.-based designer accessories theater, turn around the health policy of an individual, a year ago, she found higher premiums and expenses for maternity services, as in his previous employer provided plan. Hence only a Kaiser Permanente HMO family plan does not require a waiting period for this benefit at age 39 and she said she was concerned by attempts to postpone pregnancy.

However, Leonard became pregnant before they can submit an application and deny coverage to Kaiser Permanente.

"I was disgusted widely is essential that there is a gap if you are pregnant, you can not have [person] of insurance and, if you have insurance, you can not get pregnant" said Leonard.

Ultimately, she qualified for a Medicaid program that provides maternity coverage to women who have incomes 200% or below the federal poverty line.

"A lot of women after a hard, cold reality when they lose employer coverage," said Lisa Codispoti, Senior Counsel of the National Women's Law Center (nwlc), which conducted a 2008 study of gender differences in terms of cost and other factors the market for individual health. "It never gets up on them is something that is not covered.

The federal Civil Rights Act requires all employers with 15 or more employees that offer health insurance to provide maternity services for employees and dependent spouses, but that protection does not extend to the individual market . Workers who lose their jobs may choose to sue their employer under the cover of Cobra law, put in place must take the full cost of coverage.


Without employer insurance, even though, to find the maternity coverage is difficult. Only 12% of 3500 health insurance plans available in the individual capitals of 47 states through eHealthInsurance.com, a leading insurance market online to consumers, offers comprehensive maternity, including antenatal care coverage, the childbirth and post-natal care routine and complicated pregnancies, according to nwlc of research.

Non-comprehensive maternity care was provided by another 9% of plans, availability and plans for maternity coverage varies greatly between cities.

Why buy at all?

A common way to maternity coverage is to load a driver over the regular monthly premium. The study showed that the riders range from $ 106 to $ 1100 per month, the waiting time required for one to two years, with little or no coverage during this period and capped the total maximum benefit as little that $ 2000 to $ 6000.

Given that the average cost in 2006 of a hospital-based mere dollars in 7488 - although considerably higher for sections C and most complicated births - number of women would end up spending less on maternity care, if they paid all expenses out of pocket instead of buying a rider.

Although maternity is not covered, women aged 18 to 55 are likely to pay from 4% to 48% longer than men the same age for individual policies through a practice known as " gender view, "the insurers say, is necessary because women use more health services in general.

Only 6% of women between 18 and 64 have purchased insurance in 2008 and an additional 18%, or nearly $ 17 million, were uninsured, according to the Kaiser Family Foundation.

The demand for more choice

While the exclusion of maternity coverage or offering high-cost May seem unfair, the practice is truly consumer-driven than in men and women does not require kinship menu with choice of plan lower premiums, said Susan Pisano, Vice President of Communications for the American health insurance, a major industry trade association.

"Waiting times in the heart of how the coverage works in that it is something that is voluntary," she added. "In the individual market, you can choose to buy or not not buy [maternity] coverage when you need it. "

Wellpoint Health Networks Inc., which sells individual plans under Anthem Blue Cross Blue Cross and other subsidiaries in 14 states, is seeing a general trend of consumers buying less expensive plans, said Richard White, Vice President of Product Management Wellpoint for the individual enterprise.

The insurer offers plans that include maternity coverage in all states and all Wellpoint catastrophic individual plans cover complications of pregnancy, and that many plans by their competitors, he added. "A normal delivery is systematic in that it is something you know is going to happen," White said. "The real event is insurable if there are complications, the sky, is it something wrong with the child? "

States is to

The issue has triggered an ongoing debate in California, where the state assembly is considering legislation that would make it the sixth state to mandate that insurers must cover prenatal care, childbirth and postpartum services in all insurance plans.

Similar laws have passed in Massachusetts, Montana, New Jersey, Oregon and Washington, but the previous two were adopted by the state legislature of California and vetoed by Governor Arnold Schwarzenegger.

The disparity in the coverage of maternity as a fair and equal rights for women, which also ensure that babies receive prenatal care, "said Hector de la Torre, of the State of California Member assembly who introduced the bill in 2009 maternity mandate.

"The whole concept of the insurance market is that you spread the risk among all the people who are in it," he added. "I'm never going to breast cancer, but it's part of my policy. A woman is never going to prostrate cancer, but it is part of its policy."

At the California mandate maternity coverage to individual plans raise premiums up to 13% depending on enrollee age, according to an analysis of last year the potential impact of the bill by the California Health Benefits Review Program .

The same analysis found that even this modest increase in 2300 to convince Californians to drop health insurance and join the ranks of the insured, "said Anne Eowan, Vice President Government Affairs / Secretary of the Association of California life and health insurance companies, which is opposed to the measure.

While many insurers, including Blue Cross of California, the state's largest provider plan and a subsidiary of Wellpoint, oppose the mandate maternity laws, Kaiser Permanente, co-sponsored a bill in 2004 which vetoed and Blue Shield of California has supported past efforts.


Another wildcard is the drive to reform health care led by President Barack Obama. If the legislation was passed that allowed individuals to purchase larger pools such as Medicaid or federal employees, then the gap between the coverage of maternity on the individual and group may disappear, said Codispoti .

How to buy an individual policy

For now, women family planning can reduce costly surprises by insurers thoroughly that the questioning of an individual policy coverage and costs in May, they must pay themselves, "said Alina Salganicoff, Vice President and Director, Health Policy Women's Kaiser Family Foundation.

Key issues recommended by Salganicoff include:

Women planning families who are eligible for Cobra coverage through their previous employers must weigh the benefits and costs of maintaining these plans in relation to the changing market, in the White Paper said Wellpoint . Although often expensive, the federal stimulus legislation included a subsidy of 65% of Cobra coverage for up to nine months.

In addition to Medicaid, some states including California and New Mexico have programs sponsored by the state that provide assistance to women with plans that do not completely address the needs associated with pregnancy.

If a woman does not have maternity coverage, or benefit of a health program, some hospitals allow patients to negotiate a discount or payment plan to reduce shipping costs.

For example, Northside Hospital in Atlanta, the U.S. leader for the number of babies born each year to 17,442 in 2008, offers a 40% discount to self-pay patients and offers a variety of payment plans, said Russ Davis, director of hospital marketing and public relations.

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