Pregnancy in 2013? Questions To Ask Insurance About Your Coverage

December. This is am important month for many things. But it may be an important month for something you may or may not have considered. Open enrollment for insurance! Yay! Ugh, I’m already bored to tears. However, I have had to do a lot of research and lots of chatting up with my girlfriends about insurance-to-be, or not-to-be.

Since we are planning on getting pregnant in 2013, it is super important to make sure we have coverage for that whole sitch* now. December is the time for open enrollment with changing, upgrading, or opting in to insurance through your company, your husband’s company, cobra, or individual plan.

There are so many different options that your company may or may not offer, it is important to get in touch with your HR rep to see what will be covered or if you need to open an FSA or HSA insurance account.

I would suggest talking to your rep first before chatting up with your friends or family because I did that, and I got all freaked out about the type of plan I needed to get and once I spoke with my rep, I felt much better because I knew exactly what would be covered.

I can completely admit that I am a control freak, but I already told my husband that I do not want to have to deal with insurance while I am laid up in the hospital with a newborn. So I wanted to call and see what was covered, what was not, and what my HUSBAND needed to do with the insurance to make sure that everyone is covered.

Things to ask your HR rep or insurance agent about pregnancy coverage:

• What is my deductible?
• What is my co-pay?
• What is covered once pregnant? Check-ups, tests, labor, delivery
• If the baby is born in the same year as conceived, what is the deductible and when it is due so the baby will be covered?
• Do you offer HSA?
• Do you offer FSA?
• Are there any procedures that need to be pre-approved?
• What is the percentage that is covered and what percentage is out of pocket? 
• What if I need to see a specialist? 
• What, if any, is the policy coverage limit?
• What if complications, pre-mature birth? What will be covered?
• I am trying to get pregnant. Am I covered for maternity currently through my policy? If not, what steps do I have to take?
• How long does my maternity coverage last?
• Is there an out-of-pocket max?
• Can you offer me a list of good OBGYN that are in my network (that are approved and covered by insurance.)

********I want it noted on my records right now that when the baby is born he or she should be added to my policy. (If you don’t have this noted before delivery, you will have to call the day the baby is born, otherwise all expenses related to infant care up to the time you make the phone call will not be covered.) This needs to be noted with your insurance company or agent. 

It is very important to ask if your plan covers midwives, nurse practitioners or any other pregnancy-related professional you plan on seeing for your care. Some plans only cover physicians.


Remember, right now is the time to call to see if you can make any changes. After open-enrollment is over (typically Dec 31,) you can’t make changes.

*Sitch = situation.