Thursday, May 23, 2013

Does Your Group Health Plan Cover Pregnancy for Your Adult Child?

Many parents were extremely happy when the health-care overhaul allowed their adult children to be covered under their health plans until their child reaches the age of 26. This includes if they're married, living on their own and financially independent.

With an estimated 2.8 million women ages 15 through 25 getting pregnant annually, this expanded coverage window means that more adult children will likely become pregnant while on mom and dad's plan.

Some parents have been in for a shock when they find out that this coverage does not include their daughter's pregnancy.

A big misconception

Under the Pregnancy Discrimination Act of 1978, employers offering group health plans to 15 or more employees must provide maternity benefits for employees and their spouses.

However, they are not required to extend this benefit for those employee's dependents.

What must be covered by some plans

New plans and plans that have lost their "grandfathered" status have a different set of rules they must abide by.

While the pregnancy and delivery itself are not covered, by law certain preventative health benefits must be offered to young pregnant women covered under their parent's plan.

The U.S. Preventive Services Task Force stipulates that a range of screenings for pregnant women - including those for anemia, hepatitis B and Rh incompatibility - must be covered.

Additionally, effective this month these plans must also provide an annual well-woman visit, screening for gestational diabetes and breast-feeding support, supplies and counseling.

The future

The Affordable Care Act of 2010 requires that health insurance plans sold to individuals and small businesses provide a minimum package of services in 10 categories called "essential health benefits." These include hospitalization, maternity and newborn care, ambulatory care, and prescription drugs.

As a result, starting in 2014, maternity and newborn care must be offered by all health plans in the individual and small-group markets.

This law will also apply to any plans sold through the state-based health insurance exchanges that should be up and running then.

Who does the new law not apply to?

Because health benefits at large companies are typically more comprehensive than those at small companies or individual plans, large group plans are exempt from the requirement to provide the essential health benefits, now or in 2014.

Women's health advocates are hoping that large companies will offer these essential health benefits, including maternity and newborn care voluntarily.

Additionally, the Department of Health and Human Services (HHS) will not be establishing a national standard. Rather, they have decided to allow each state to choose from a set of plans to serve as the benchmark plan in their state. Whatever benefits that plan covers in the 10 categories will be deemed the essential benefits for plans in the state.

This may or may not include maternity and newborn care.

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