Your Pregnancy After 35 : Your Career and Your Pregnancy (part 5) - Insurance-Coverage Questions, Laws That Protect You during Pregnancy

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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.

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