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 on the individual market (for example, on the health insurance marketplace) must cover 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 you are enrolled in a grandmothered plan, 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 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; CMS, Insurance Standards Bulletin Series – INFORMATION – Extension of Transitional Policy Through 2022, January 19, 2021).

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