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Maternity Benefits
Prenatal care is essential for a healthy pregnancy and baby. Many insurance companies cover prenatal care and delivery, but some do not. Please be advised as an individual you must purchase maternity coverage as a rider and abide by the waiting periods before conception. Medequote offers Illinois health Insurance plans with optional maternity from BCBSIL, and Assurant.
You are going to pay extra for individual and family maternity coverage, and unless you are in a group, the coverage is not immediate, in fact you may have a waiting period to coceive of up to 12 months. Be sure to give us a call at 800-391-7469 if we can answer any of your questions.
Here are the basic facts about maternity coverage in Illinois.
Who Must Offer the Coverage?
Illinois requires all health maintenance organizations (HMOs) to cover all medical costs associated with pregnancy. But, Illinois does not require insurance companies to provide normal maternity benefits in either group or individual policies. However, insurance companies are required to provide benefits for complications of pregnancy such as toxemia or latent diabetes.
Federal law requires employers with 15 or more employees to treat pregnancy as any other illness. Those employers must provide benefits for maternity care. The employer may provide the benefits directly or through an insurance company. To find out if you have maternity coverage, ask your employer, check your insurance policy, or call your insurance companyıs customer service representative.
If an accident and health or HMO group policy provides maternity coverage that is renewed or issued on or after July 1, 1997, the insurance company or HMO may not exclude or limit maternity as a preexisting condition.
Early Notification
Contact your insurance company or HMO as soon as you know you (or your covered dependent) are pregnant, preferably within the first three months. Insurance companies and HMOs sometimes offer additional benefits, such as lower copayments, if you contact them early and you follow appropriate prenatal guidelines. They can also explain what is covered and what you must do to receive maximum benefits. You will then have an idea of what you will be expected to pay for the pregnancy and delivery.
What is Covered?
Insurance companies that provide maternity coverage and all HMOs must pay for:
- at least 48 hours of inpatient hospital care for mom and baby after a normal delivery;
- at least 96 hours of inpatient hospital care for mom and baby after a cesarean section delivery.
Your doctor is the only person who can decide to discharge you before the minimum time. If he or she decides you and the baby can be discharged prior to the minimum time, your insurance company or HMO must then provide coverage for:
- a home nurse visit for you and the baby within 48 hours after discharge; or
- a doctor's office visit to check the baby within 48 hours after discharge.
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