So, you live in Utah and you're looking to expand your family and you don't have coverage through an employer. You need to know what your options are and how you are going to afford to have this child but also not break the bank paying the premiums. We are going to cover what you can do to make sure that this baby has the best possible insurance for the least amount of dollars. One of the things to remember as we go through your options is that because Intermountain Healthcare facilities only take SelectHealth on an in network basis, if you choose a doctor that only has privileges at a IHC facility, your only real option is SelectHealth insurance unless you choose a different doctor.
The next thing we need to talk about which carriers cover maternity here in Utah and how they cover it. First we'll deal with who doesn't. Currently, HumanaOne does not cover maternity at all. The only real option with them is to use one of their HSA option plans and combine that with a hospital indemnity plan (which we will discuss later). Otherwise, they will not cover anything other than complications with the delivery.
SelectHealth will cover the pregnancy and delivery but only after a separate $6,500 deductible for maternity. But obviously with the amount of doctors in network for them and since their parent company, Intermountain Healthcare (IHC), is the largest health provider in the state, they always have to be looked at. They too will always cover complications as part of their regular health coverage. The one thing to remember with SelectHealth is that they will also only cover maternity in their own Intermountain Healthcare hospitals on an in-network basis. So, they will cover you in network at American Fork Hospital but not at St Marks in Millcreek.
Assurant will have the best coverage as far as deductible is concerned here. They have as low as a $1,000 maternity deductible. That means that after you pay $1,000 towards maternity care, your coverage will then kick in. Now, the only real problem is that your premiums are going to be very high since they know that with that low of a deductible that you are definitely going to use the coverage. Since the birth of a baby can cost anywhere between $6,000 to over $10,000 depending on complications or C-section, you can see that if the premiums weren't more, the insurance companies would go broke trying to cover it all. Same thing goes for Assurant, but opposite of SelectHealth. Their coverage is good at non-Intermountain Healthcare hospitals, like St Marks or Orem Community, but not at the IHC facilities like Intermountain Medical Center in Murray.
Regence BlueCross BlueShield has a $5,000 deductible for maternity coverage and also has a great network of doctors to go to. They also follow the networks of Assurant, so make sure you doctor hospital privileges aren't at a IHC facility.
Altius also offers coverage, but they have the highest deductible at $7,500.
Hospital indemnity plans are also an option. Since your health plan make not kick in until a certain deductible, how can you get covered without breaking the bank. That is where these types of plans come in handy. These plans will help cover the costs you incur while admitted to the hospital for child birth. That way, to help meet your maternity deductible on your health plan, the indemnity plan pays it for you. So, you will still incur the OB/GYN visits during pregnancy, but the real expensive ones on the hospital get covered. So, as an example of how this type of coverage would work, let's use it in conjunction with a SelectHealth plan. You get pregnant and you start your prenatal visits with your OB/Gyn. These visits will come out of your pocket, but will count towards your deductible. The ultrasounds and lab work will also be paid out of pocket and then count towards deductible as well. Then labor strikes and you are admitted to Utah Valley. The indemnity plan then would kick in and cover the charges incurred while you were there, but at the same time, the costs paid by that plan would also go toward your SelectHealth deductible. Once you reached $6,500 in expenses paid, your SelectHealth plan would kick in and cover the rest of the charges. Sounds pretty easy right? There is more to it than that, so do speak to an expert so they can walk you through what to do.
Now, what can you do if you can't afford any of the options? In the state of Utah, they have a great Medicaid program that will help cover all of the costs you incur. And with some flexible options to qualifying, it is always an option to look into. Utah's Medicaid covers everything from the prenatal visits to labor and delivery to even C-sections if needed all the way to the follow up visits with a pediatrician.
The most important thing to do is to speak to an independent health insurance agent in Utah to help you sort through all of the confusion in what might be the right plan for you. Because they specialize in only health insurance in Utah, they know what carrier and plan options will fit your situation. They will help you find out if your doctors privileges are at a Mountainstar hospital, an IHC facility or even an independent facility like University of Utah Medical Center. And best thing is that they don't cost you one extra penny to help.
Whatever you choose, good luck with the family expansion. It may be a slightly stressful time, but it is definitely worth it.