QUESTION

I thought I was entitled to maternity coverage. Why isn’t it covered?

Post enrollment issues | Individual Health Insurance
ANSWER

All new health insurance plans sold to individuals must offer essential health benefits, which includes maternity coverage. However, it’s possible your plan is a grandfathered plan and doesn’t have to meet this requirement, or you renewed coverage in your plan before January 1, 2014 and your plan (often called a transitional or grandmothered plan) doesn’t yet have to meet this requirement. Your insurer must tell you if your plan is grandfathered. If your plan is a grandmothered one, your insurer was supposed to inform you that your coverage does not meet all of the Affordable Care Act's protections.

Alternatively, you may have purchased an insurance product that is not subject to the Affordable Care Act’s requirements because it is not traditional health insurance. For example, medical discount plans, short-term insurance, Health Care Sharing Ministry policies, and cancer-only policies are not considered health insurance and therefore not subject to the requirement to cover maternity care. If you believe you purchased one of these policies – and thought you were purchasing health insurance – you should notify your state Department of Insurance. See the alternative coverage section for more information.
(45 C.F.R. § 147.150).

Individuals with no coverage
Individuals with coverage
Coverage for small employers
Post enrollment issues