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Do health insurance policies cover maternity care?

  • October 24, 2011

Q: Do health insurance policies cover maternity care?

A: Not unless you work for a large employer. Individual health insurance policies generally don’t cover maternity care. According to a recent Congressional investigation based on responses from the four largest for-profit health insurers, it found that individual policies didn’t cover most of the expenses for a normal delivery. A similar national study in 2009 found that only 13 percent provided maternity coverage.

Coverage for maternity care is required under the Pregnancy Discrimination Act of 1978. But the law doesn’t apply to companies with fewer than 15 employees or to individual policies. Some states have tighter requirements. But, in general, if you don’t work for a large employer, you’re out of luck.

Under the new health care law, however, this coverage gap will close in 2014, requiring most individual or small group policies to cover maternity care as an “essential health benefit.” The new law also prohibits health plans from turning away applicants because of preexisting conditions, including pregnancy.