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Florida Maternity Example

I understand that you were inquiring into receiving information on individual maternity options.  Individual health insurance policies do not automatically include maternity benefits, but rather only cover any complications due to pregnancy.  In order to receive any coverage for routine maternity benefits you would need to enroll in a medical plan that offered maternity coverage as an optional benefit since Aetna and Humana for example do not offer maternity benefits.  Below you will find the list of insurance carriers in Florida that offer maternity as an optional benefit, the waiting period in which is the amount of time that you must have the optional maternity benefit effective on your plan before the insurance carrier will cover any routine maternity benefits, and the amount of coverage offered by each carrier respectively.

Please note that even when you have an optional maternity benefit rider on your policy, complications will still be covered as a medical benefit under the regular schedule of benefits.  For instance, if you had paid the first $1000 in your maternity deductible for routine maternity services rendered and then you had some kind of complication due to the pregnancy then the medical services for that condition would be covered with your normal benefit schedule.

So if you had Plan 597 with a 2500 deductible for instance, all routine maternity doctor visits and delivery would go towards your 1500 or 2500 maternity deductible that you selected.  If there were any complications during the pregnancy or at the time of delivery then any doctor visits for those complications would be subject to your plan’s respective copayment amounts; and other inpatient medical services rendered for complications such as an emergency C-section would be subject to your calendar year deductible of $2500.

Insurance Carrier Waiting Period Level of Benefit
Vista 15 months $1000 Copay and a one time est. $40 copay for all prenatal services
United HealthOne Effective Immediately You pay 20% and UHC pays 80% up to a maximum benefit level of $2000 for the first two years that the benefit is effective on your policy
AvMed 12 Months $5000 Maximum benefit amount

VISTA HEALTHPLAN OF SOUTH FLORIDA, INC. Rider to HMO Certificate of Coverage Individual Plan 20AB Maternity Rider Vista Healthplan of South Florida’s individual policy is hereby amended and supplemented by the terms and conditions of this Rider. Nothing contained in this Rider will be held to vary, alter, waive, or extend any of the terms, condition, provisions or limitations of the Policy to which this Rider is attached, other than as specifically stated herein.  In the event of a conflict between the provisions of this Rider and the Policy, the provisions of this Rider will prevail. EFFECTIVE DATE: Your Policy is amended as follows: Maternity Coverage is effective fifteen (15) months after the individual’s effective date of coverage under this Rider . However, an individual who is pregnant prior to the effective date of this Rider and who qualifies as HIPAA-eligible will not be subject to the fifteen (15) month maternity benefit waiting period. The Subscriber should notify Vista Healthplan of South Florida in writing upon first receiving a diagnosis of pregnancy.  Forms are available from VISTA-SFL or your OB-GYN physician’s office.  However, in order for the child to be covered, notification that a newborn child born to the Subscriber should be received by Vista Healthplan of South Florida no later than sixty (60) days from the moment of birth . Please refer to the Newborn Coverage provision in the policy for enrollment and coverage details. Maternity coverage includes obstetrical and maternity care received on an inpatient or outpatient basis including medically necessary prenatal and postnatal care of the mother. This benefit also includes post delivery care including a postpartum assessment of the mother and the performance of any medically necessary clinical tests and immunizations in keeping with prevailing medical standards and may be provided at the hospital, at the attending physician’s office, at an outpatient maternity center, or in the home by a qualified licensed health care professional trained in mother and baby care. Coverage includes the services provided in a licensed birthing center and the services of certified nurse-midwives and licensed midwives. Physician Services/Certified Nurse-midwives and licensed midwives   Hospital services include, but are not limited to anesthesia, x-rays and laboratory services for conditions relating to the pregnancy: Normal/Cesarean Section Delivery $1,000 Copayment All the terms, conditions, limitations and exclusions of the Contract/Certificate of Coverage apply to the benefits provided by this Rider.


United Health Care Maternity Riders

Maternity Benefit

This option is available with Plan 100®, Plan 80SM, Saver 80SM, Copay

SelectSM, and Copay SaverSM; not available in AR, MD, NC, or VA. This optional benefit helps cover the costs for routine pregnancy and [C2] delivery. You pay 20%; we pay 80% of covered expenses. After 4 benefit years, the maximum covered expense amount is $7,500.

No covered expenses will be considered for reimbursement for a pregnancy beginning before the maternity benefit’s effective date.

If you purchase name-brand when generic is available, you pay your generic copay plus the additional cost above the generic price.

*We have a preferred drug list, which changes periodically. Tier status for a prescription drug may be determined by accessing your prescription drug benefits via our Web site or  by calling the telephone number on your identification card. The tier to which a prescription drug is assigned may change as detailed in your policy/certificate.

Benefit Years | Maximum Covered Expense   |  Maximum We Pay
1 & 2                            $2,500                                                 $2,000
3 & 4                           $5,000                                                 $4,000
5+                                $7,500                                                $6,000

Avmed Maternity Details

Maternity Benefit Rider AvMed