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Maternity benefits under an employer group health insurance plan are common place and have been for years. Even when group plans moved away from having a separate maternity benefit to covering maternity "as any other illness" the benefit was designed for an employee and their spouse.
Apparently Wendy Kline didn't get the memo.
When Wendy Kline learned this spring that her 17-year-old daughter was four months pregnant, she took her to the doctor for prenatal care. Her insurer denied the claim, citing her employer's policy not to cover maternity care for dependents.
"At that point my jaw hit the floor, because I did not know how we were going to pay for this," Kline says.
Kline asked her company, a medical equipment retailer in Martinsburg, W.Va., to change its policy. But company officials turned the 26-year veteran employee down.
"You work all your life and pay these insurance premiums," she says. "Then you ask for help and can't get any. It's just so unfair."
Unfair?
How about the fact that plans do consider a (mostly planned and 100% preventable) condition as an illness?
How unfair is it that Wendy Kline felt her employer should rewrite their health insurance plan just to benefit her and her daughter?
Seems a bit selfish to me.
And what good is a story like this if you don't include a tie in to Obamacare?
Starting in 2014, maternity and newborn care is one of 10 so-called essential health benefits that must be offered by all health plans in the individual and small-group markets, including those that are sold through the state-based health insurance exchanges that will be up and running then.
Now the government is defining maternity as an essential health benefit.
Maternity benefits are already included in almost every small group health insurance plan but is a rarity for individual major medical, thanks in part to Obamacare.
In Georgia, prior to Obamacare at least half a dozen carriers offered maternity benefits either as an added rider or built in to the plan. Once Obamacare became law all but two carriers dropped the offering and a few months later Kaiser dropped the coverage once they were able to file a new policy form with lower rates.
If you want maternity today you only have one option, BCBSGA. The cost of the rider is roughly $300 per month and requires the policy be in force for 12 months before you can access the benefit. In addition, the cost sharing by the insured is $5,000+ which is roughly 60% of the cost of a routine delivery.
Wonder how Wendy Kline feels about that?
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