Health Insurance
Most employers offer some type
of health insurance to their workers—private
medical-and-hospitalization coverage, membership in a health
maintenance organization (HMO) or a preferred-physicians plan (PPO).
With private insurance, you can choose your own healthcare provider.
With an HMO, you choose a healthcare provider affiliated with the
group. With a PPO, you may choose any healthcare provider on a list of
acceptable physicians and other healthcare providers.
Insurance-Coverage Questions
You will need answers to some important
questions about pregnancy coverage under your insurance plan. Talk to
the people in the personnel department or your employer’s
human-resource specialist. You may want your husband to ask these
questions if you’re covered through his employer.
•What type of coverage do I/we have?
•Are there maternity benefits? What are they?
•Do maternity benefits cover Cesarean deliveries?
•What kind of coverage is there for a high-risk pregnancy?
•Do I/we have to pay a deductible? If so, what is it?
•How do I/we submit claims?
•Is there a cap on total coverage?
•What percentage of pregnancy and birth costs are covered?
•Does coverage restrict the kind of hospital accommodations I may choose, such as a birthing center or a birthing room?
•What procedures must I follow before entering the hospital?
•Does the policy cover a nurse-midwife (if that is what you want)?
•Does coverage include medications?
•What tests during pregnancy are covered under the policy?
•What tests during labor and delivery are covered under the policy?
•What types of anesthesia are covered during labor and delivery?
•How long can I stay in the hospital?
•Does payment go directly to my healthcare provider or to me?
•What conditions or services are not covered?
•What kind of coverage is there for the baby after it is born?
•How long can the baby stay in the hospital?
•Is there an additional cost to add the baby to the policy?
•How do I/we add the baby to the policy?
•Can we collect a percentage of a fee from my husband’s policy and the rest from mine?
Laws That Protect You during Pregnancy
The Pregnancy Discrimination Act
The Pregnancy Discrimination Act of
1978 requires companies employing 15 or more people to treat pregnant
workers the same way they treat other workers who have medical
disabilities and cannot work. The law prohibits job discrimination on
the basis of pregnancy, childbirth or related disability. It guarantees equal treatment of all disabilities, including pregnancy, birth or related medical conditions.
Your employer can’t fire you or force you
to take mandatory maternity leave because you are pregnant. You are
also protected in other ways.
•You must be granted the same health, disability and sick-leave benefits as any other employee who has a medical condition.
•You
must be given modified tasks, alternate assignments, disability leave
or leave without pay (depending on your company’s policy).
•You are allowed to work as long as you can perform your job.
•You are guaranteed job security on leave.
•You continue to accrue seniority and vacation, and you remain eligible for pay increases and benefits.
If your company does not provide
job security or benefits to other employees, it does not have to
provide them to a pregnant woman.
Pregnancy Leave
Pregnancy leave is the period
during which your healthcare provider states you cannot work. This can
range from 4 to 6 weeks after a vaginal delivery to 6 to 8 weeks
following a Cesarean delivery. (Fathers are not covered under this law,
but see the Family and Medical Leave Act below.)
If you have problems obtaining
these benefits from your employer, tell your healthcare provider. He or
she may be able to direct you to someone who can help you.
