‘Tis the season for open enrollment! We both took a good long look at our benefits and elections last year as we were both in the family planning stage of life. Since getting pregnant and having (or soon to have!) our first kids, we’ve had quite a few friends and coworkers ask about the nitty gritty of it when it comes to insurance, finances, and how to plan for this particular life event. So we’ve put together this list of questions to ask during open enrollment, though it could also be helpful at other job junctures like interviewing for a new position and learning about the company’s benefits, negotiating your maternity leave (yes, this is something that can be negotiated!), etc.
Two of the most important questions you’ll want the answer to is: What is my in-network vs out-of-network deductible? What is my out-of-pocket maximum both in-network and out-of-network? This lets you know the maximum you could be accountable for during your prenatal visits, labor and delivery, post-natal consults, and everything in between. Depending on the selection you make for your pre- and post-natal care, in-network coverage might cover basically all of your costs, or an out-of-network provider might be billing you for everything upfront and then you’ll have to deal with submitting for reimbursements from your insurance company post-birth. Knowing these max numbers can help put your mind at ease to know that there is a limit on what you’ll be paying. It also might incentivize doing the extra research and phone calls to find in-network providers so that you are only on the hook for copays and your insurance foots the rest of the bill. Definitely a very personal choice, but one you should make only after you’re well-informed on the financial ramifications.
What is your parental leave situation (short term disability, FMLA/CFRA, PDL)? Does your company provide extra parental leave?
While we are lucky to live in California and have access to both short-term state disability insurance (SDI) as well as FMLA/CFRA and pregnancy disability leave (PDL), maternity leave policies vary widely based on where you live. Definitely check out your state’s employment website for the policies and requirements based on your area. Your HR department might be a good place to start, though some companies do not have a lot of experience with pregnant employees and won’t be able to answer your questions as in-depth as you might want. Do your own research as well as talk to HR and other coworkers that may have gone through a maternity leave recently.
A few things to check in with your HR department or employee handbook on:
- Does your company offer a “baby bonus”? This is not super common, but some companies out there dispense an extra $100-$500 to any new parents (moms and dads, alike!), so if this is a benefit your company offers, make sure your HR or payroll team is aware that you’re about to have a kid.
- What is the special enrollment period you should be aware of? This is usually within 30 days after birth where you are allowed to add dependents and make adjustments to your insurance coverages and elections. Some companies have shorter periods (we’ve heard of as few as 5 days post-birth!) and some give you a little more wiggle room, so just be sure you’re aware of the time you have, so that you’re sure to add your new addition to your insurance for all those pediatrician appointments you’re about to have!
For California readers, we love this blog post on maximizing maternity leave benefits and this post on calculating your SDI and PFL payment amounts.
Does your company provide adoption or fertility benefits?
More and more companies are providing adoption and fertility benefits to their employees, so be sure to check to see what is available to you. Some companies offer up to $40,000 per employee to aid in the cost of IVF cycles, diagnostic tests, ultrasounds, egg retrieval, ICSI, embryo assessment and transfer and egg freezing consultation.
We like this post on more in-depth questions to ask surrounding fertility benefits during open enrollment.
Health Insurance-Specific Questions
There are probably a million questions going through your mind if you’re in the early stages of family planning. We’re sure insurance coverages are only a few of them, but it can be helpful during open enrollment to have somewhat of a rubric for the different plans you’re deciding between. Ideally your company has one phone number, such as a Health Advocate program, that you can call that has all the information about the multiple plans to help you compare; however, if it comes down to it you can also make the calls to the different plan providers with this list of questions to compare what coverage is offered. This is by no means an exhaustive list, but can give you a basic understanding of some common costs and coverages during pre- and post-natal care and labor and delivery.
- How long is the coverage hospital stay for a vaginal birth vs. c-section?
- Are lactation consultants covered post-hospital stay or post-birth? At what rate? Are there in-network consultants I should be aware of?
- What breast pumps are covered under my plan? Do you cover the cost of a hospital-grade rental if necessary? (Check out healthcare.gov for more breastfeeding benefit requirements for equipment and counseling.)
- Does my plan cover other things related to pregnancy such as childbirth classes or doula care?
- Will I need preauthorization for any of my prenatal or maternity care?
- What coverage does the plan provide for prenatal tests such as ultrasounds, diagnostics, carrier and DNA screening, and amniocentesis procedures?
- If I use a birth center, midwife, or out-of-hospital birth: will I be required to cover fees for any of the required state testing (newborn panel, hearing screen)? (Those things are usually covered and provided for in-hospital births.)
One More Thing
Regular dentist visits are important in regular life, but become even more important while pregnant. Hormone fluctuations can increase the risk of gingivitis and periodontal disease, so it’s even more valuable to keep your dental exams regular throughout pregnancy. One thing we both learned while pregnant is that most dental insurance companies will cover a third appointment per calendar year for expecting mothers beyond the regular two. All you need to do is call your insurance provider to check if this extra appointment is covered and, if so, let them know that you’re pregnant and to anticipate a third appointment for you.
Anyone recently pregnant and missed out on some insurance or company-provided benefits because you elected wrong during open enrollment? Have any tips or other questions to remember while calling your insurance company?? Let us know in the comments!