Some of you may remember I posted a dilemma regarding maternity benefits and health insurance. The problem was that many group health plans do not cover maternity for “children” on their parent policies which they can remain on until age 26. The problem is that most of these families believe their is maternity coverage due to the ACA mandating maternity coverage be included, even for men.
I am not arguing whether or not dependents should have the coverage (not in this post anyway!) it just irks me that I have not spoken to anybody who was aware of it. I think it would be reasonable to have a check box that must be checked to acknowledge when you add dependents to your healthcare plan, that certain coverages are EXCLUDED for dependents. (Is anything besides maternity excluded for dependents?) This might cause some families to at least mention it to their daughters. At the very least they might realize it when they first become pregnant so they don’t run up bills before they realize they don’t have coversge. It would be nice if doctors offices were more aware as well. In addition, the timing could be such that they miss open enrollment while they are pregnant, but thinking they have coverage while on parents policy. Is this check box a realistic option that could be added to enrollment forms or noted on ins. cards?
In case you wondered, it is my sons gf that is now 14 weeks pregnant! She can’t take the pill for some reason and I guess they failed at whatever method they were supposed to use. I am going to be a grandma much sooner than I expected! One bright side is that I think my dad is actually happy because he will be around for this event. He is healthy, but yet not healthy. He has some strange unexplained uncomfortable/painful symptoms that give him trouble, yet nothing definitive has been found. We think he is sure he has something rare that just hasn’t been found. He is a physician so he knows what is what. I was afraid he’d be judgmental, but I think we all are ok because what can we do? The parents-to-be have decent incomes and are old enough. We just hope they stay together and marry someday.
She was able to get coverage at the the last possible moment thru the marketplace, but based on last year she doesn’t get a subsidy. So now she has two insurances since she is still covered on moms. She may qualify for a small subsid as she is earning less this year and will gain a dependent, but it won’t be a big one. If she ends up qualifying can she get it reimbursed to her? She will go on her company plan when baby comes in September.
Congratulations Patsam! So many people have kids without being married today that, at least in my world, no one judges at all. My cousin just became a grandmother last week (baby was preemie) by S1 and his gf and S2 and his gf is also expecting a baby shortly. They both actually had almost the the same due date - but the first mom has kidney disease and is on dialysis so they had to deliver the baby last week because of her health. The great grandfather is also over the moon.
Thanks emilybee! As far as I’m concerned it was an accident that could have happened to many of us. I know it would be nice if they were married, but that’s no guarantee of happiness either. She comes from a very catholic family, but her immediate family is not as strict as some of her relatives. Her parents were ok with it and her mom is pretty excited. I think her moms parent both died soon after they were married, so her mom didn’t have her own mom when she had her kids. I think that makes her being there for her daughter now even more special. She has cousins who got married young because they were waiting for marriage. They got married and right away they had some babies, when they were younger than gf. At least one couple has to live with their parents. S1 is going to buy a house once he finds one. He had a contract on one, but cancelled it after inspections.
Secret confession, my mom and I bought a bunch of clearance stuff (3-6 months) at kohls with 30% off. It was too good to pass up. We bought boy and girl because we’ll know in 6 weeks and can return the wrong one. We didn’t tell our husbands! I hope we didn’t jinx anything by shopping so early.
Back on track here…how can I start or suggest that insurance companies make this exclusion more obvious?
I’m surprised that this exclusion exists. I handled benefits in large corporations for many years, and the rule was usually that the daughter of the covered employee would have all her maternity expenses covered, including the birth and the “well baby” stay in the hospital, but once the newborn (the employee’s grandchild) was discharged, no expenses would be covered. S/he had to be put on other coverage.
That said, corporate benefits are often different than benefits you buy on your own or through the marketplace. I’m sure you’ve checked this out thoroughly.
There are a few things about the ACA that drive me nuts, like no eye exam coverage (my old non-ACA policy covered a healthy eye exam) but I do, I think, have maternity coverage for me and my wife, age 62. That brings a huge, W T F ! And now you learn (I remember reading this in another thread) that the adult children under age 26 on the parents policy do NOT have maternity coverage. The parents, however do, right? The 50 or 60 year old parents have maternity coverage but the 25 year old kid does not. That has to be an “oops”… or something. That would have to come as a surprise to anyone thrust into a situation like yours (surprise!) and I agree it should be disclosed up front. Better yet, it should just be corrected/changed.
I haven’t researched this the way you certainly have, but I still find myself asking, “Are you sure?” I did find this on the healthcare.gov website, and for them to write this but not mention that maternity care is not included really blows my mind! (Are you sure??)
Her mom is a teacher. She apparently checked with someone in her building. Not sure what that means, maybe a union rep? Obviously, the insurance denied it since the first she heard of it not being covered was from the dr. I am assuming her parents would have checked it out properly, but I guess you never know for sure. I did google it and it is a true existing “loophole” in the ACA. Here is one link that I recently found. http://lawecommons.luc.edu/cgi/viewcontent.cgi?article=1034&context=pilr .
Congratulations, Patsam! How wonderful that you will soon have a grandchild.
To clarify the situation: if a parent buys an individual health care plan for herself that includes her adult daughter, the plan must cover maternity benefits for her daughter. The loophole that Patsam’s grandchild’s mother found is a loophole for employer-paid group plans only. It’s a nasty, unpublicized shock for some newly pregnant women and their parents. I wish it had more publicity, but the fix I’d prefer is to force employers to cover all of the pregnant woman’s health care.
It is not a “subsidy” – it is an “advance” tax credit.
When she does her tax return for 2015, part of the process will be reconciliation of the amounts she paid in premiums during the months she was on the exchange, as against her reported annual income. If she and your son get married & filed jointly, the reconciliation will still be done, but it’s a little more complicated.
Depending on how the numbers come out, she may or may not qualify for a tax credit, which she could receive in the form of a tax refund.
The good news is that because she is not currently receiving an advance premium tax credit, there is no possibility that she will owe extra money next year. People who take too large of an advance credit, based on underestimating their income, do have to pay some or all of it back, in the form of additional taxes the following year.
P.S. My grandson came into being roughly 5 years ago under similar circumstances. At the time, DS was able to get then-GF onto his company policy by declaring that she was a domestic partner; then they had a small wedding (immediate family only) about 2 months before the birth. Grandson is doing fine, but the marriage wasn’t meant to be – they split up after about 18 months & now are divorced with shared custody.
In the meantime, some awareness via a checkbox or adding it to the website in the section where NJres says it mentions married people can be on the policies.
I hasn’t even thought about the concept that her mother, approx age 50 has maternity benfits and she doesn’t! That is nuts isn’t it!
@calmom, do you think the situation with your grandchild would have been simpler if they hadn’t gotten married and then still split up? I feel like a divorce just adds another layer of complication, although it may also add a layer of commitment.
The gf has a ginormous family. Her dad is one of approx 10 kids. She has at least 20 cousins and more 2nd cousins. I don’t even know that many people! If they ever get married I hope they do a destination wedding and keep it small., but somehow I think the giant families expect giant weddings…
I don’t oppose that idea, but I also don’t think it’ll make much difference, especially for unexpected pregnancies. Your son’s gf’s mother was, I’m sure, not thinking that her daughter would get pregnant when she signed up for the plan, so it probably wouldn’t have registered with her.
It’s the usual thing with buying insurance, and the whole point of the ACA: people need to insure against events they don’t expect will happen. But then when the unexpected event happens, the person is insured against it.
@Patsam -I don’t know what would have happened in terms of my son’s parental rights & custody issues. I would have been happier if they hadn’t gotten married – my son would have needed to be very proactive to establish his legal rights. Son & grandson are very close. I also think that if they hadn’t married, our relationship with her parents might be more difficult – son & ex live in one state, but her parents live within about 45 minutes from me, so the ability of the grandparents to get along and work together is a big plus-- especially as grandson grows older. I just don’t think they would treat him with quite the same level of respect if there hadn’t been a marriage.
But when my daughter was in high school I made sure to buy her a plan that covered pregnancy, even though that was more expensive - and I had dropped those benefits myself - and I can assure you that I didn’t want or any way expect for my kid to get pregnant. (And she didn’t & doesn’t plan on starting a family until later in life) – but to me it’s essential coverage for any female of reproductive age. I mean, I can’t imagine anything worse than an unplanned pregnancy where lack of insurance creates an economic pressure to terminate. I’m 100% pro-choice… but it’s not a “choice” if the decision is made for economic reasons.
Most people aren’t as conscientious as you, calmom, or as dogged. You would have noticed that your daughter wasn’t covered, but most it would have come as a shock to most people.
I remember this being an issue in the renewal for a health care plan I was vetting when I worked for an employee benefits consulting group. It was buried within the documentation, but it was not highlighted in the employee-friendly benefit overview that the insurer had prepared for the company to give its employees. I insisted that it be included in the overview, because I thought it might be important … as this thread illustrates, it certainly can be a surprise that comes at the wrong time.
I can’t find anything about it in the info about my husbands plan. They don’t seem to give a complete description of the coverages. I think that is something that needs to be changes. Thanks Kelsmom for attempting to inform the employees. I have a feeling that not everybody in your position would realize its importance.
Wow, that is a big gap. I know of very few moms who have had babies at 50 or beyond, while many have had their under 26 kids have babies. This is an important thing for families (especially folks under 26) to know. Our kids have been covered under H’s insurance until age 26 and we assumed it would provide complete coverage.
It was interesting to us that S had coverage even though he could have gotten coverage from his own employer and was fully financially independent and lived 5000 miles out of state. D will age out of coverage this fall, so we are hoping she is able to get a job that provides coverage or we will have to buy her some medical insurance.
The situation was really annoying to me because the girl thought she had insurance for everything. If she had know she could have gotten insurance at her job. She works full time, but figured why pay for insurance when her parents are buying dependent coverage anyway for the family. I feel like she should have had an option to drop her parents coverage and go onto her own with work, but this isn’t a qualifying event. Now she has double coverage. (Except,for maternity!) if she had missed the ACA enrollment she would have been really screwed by the ACA provision which let her stay on parents policy. She squeaked in under the deadline that was extended for one week. If this happened in April it,would have been quite a problem. Luckily she only has to pay for coverage until baby comes, then she can go on employer plan, or back on her parents if S1 goes on employer plan with baby. He ages off in April anyway. I told her she better find some birth control that is better than whatever they were doing, or make that NOT doing.
Well, I disagree about the notice thing for one reason only: I think that the regs should be changed to require that maternity coverage be included within the dependent coverage! They shouldn’t be allowed to have any exemptions for dependents that wouldn’t be allowed for the primary covered individual.
My son just got a new job & has asked me to help him decide among insurance options,-- I’m mildly curious so I’ll see if there is anything noted, though I am very confident that my 5 year old grandson is never going to need maternity coverage!
Back in the day when I was buying separate policies on the individual market for each of my kids, my daughter’s insurance always cost about $50/more than her brother’s, because of the extra cost of the maternity coverage. But she’s had employer coverage since she got her degree in 2010.
I happen to read an article/column about this very topic but it was on a certain news service that is not considered of credible on cc, so I never posted the link.
Patsam, if you’re interested in reading just about everything about your plan, ask your benefits person for the Summary Plan Description (SPD) and either the Plan document or the insurance policy. There will only be one of those – a Plan document if your company self-insures the plan, or an insurance policy if your company buys insurance.
