Surrogacy Health Insurance | FAQs for Intended Parents
Q: What options are available for surrogacy health insurance?
A: The three major types of health insurance available for surrogate pregnancies are employer-provided policies, individual health insurance policies, and policies designed specifically for surrogate pregnancies. Sometimes, a combination of insurance policies, possibly in conjunction with a cash-pay arrangement, is used. Generally, using a Medicaid program (such as Masshealth) would not be an appropriate method to pay for the medical expenses associated with a surrogate pregnancy.
Q: Will my insurance cover a surrogate pregnancy?
A: The good news is that many insurance policies do cover maternity care provided to a gestational surrogate. However, sometimes it can be tricky to figure out whether a policy will or will not work for a surrogate pregnancy. As this is a very technical area of the law. I recommend that you have your attorney or insurance agent (such as ART Risk) review the policy directly in order to provide you with a specific opinion tailored to that particular insurance policy. Keep in mind that coverage varies from policy to policy, and state to state, and not all plans offered by a certain insurance company will have the same benefits available. So your friend's experience with Anthem, Cigna, Aetna, United, Harvard Pilgrim, etc. may not be equally applicable to your policy.
Q: What is a "surrogacy exclusion"?
A: Many surrogates have health insurance policies that cover maternity care, such as prenatal, delivery, and postpartum treatment. However, some insurance companies try to carve out an exception for surrogate pregnancies. The effectiveness of these carve-outs varies widely, and it it best to have your attorney or insurance expert review the exact language used to determine whether the attempt to exclude surrogacy is likely to hold up under your particular circumstances.
Q: I read that under the Affordable Care Act surrogate pregnancies must be covered as an "essential health benefit". Is this true?
A: It remains to be seen how the essential health benefits mandate will interact with surrogacy exclusions written into the policy. For example, in New Hampshire, the initial ACA plans did attempt to carve out exceptions for surrogacy, but the effectiveness of these exclusion attempts has not been tested, so again we recommend discussing this with your attorney or insurance agent to understand how the ACA mandates apply to your particular policy.
Q: Who is responsible for the surrogate's medical expenses that are not covered by the surrogate's own health insurance?
A: Generally, the intended parents will ultimately be responsible for these bills. Surrogacy-specific insurance policies are available to help intended parents meet these obligations.
Q: What if my surrogate doesn't have any health insurance?
A: There are often insurance options available for surrogates who don't have insurance. It's best to have these kinds of arrangements made well in advance of the pregnancy.
Q: What is open enrollment and why does it matter?
A: Open enrollment, whether on the Exchange for ACA Plans or through an employer for group plans, gives you the opportunity to buy health insurance for your surrogate without having to prove that a “qualifying event” took place in the surrogate’s life. This is important because getting pregnant is not a qualifying event so it does not trigger the opportunity to purchase a new insurance plan. Bottom line: don’t miss out on open enrollment!
Q: Will my surrogate's health insurance cover the embryo transfer and related treatment?
A: It would be very unusual for any part of the IVF treatment to be covered by a surrogate's own insurance, although, of course, you should check to policy to be certain. Sometimes intended parents are able to get benefits from their own medical insurance for the IVF part of the process.
Q: What about medical insurance for the newborn?
A: Newborns can often often be immediately placed upon the intended parents' own health insurance plan. Newborns can also be eligible for individual coverage under the health insurance exchange plans, although potential gaps in the start of coverage can make this a less desirable option. International intended parents have more limited options when it comes to finding affordable coverage for their newborns.
Interested in becoming an intended parent via gestational surrogacy? Contact us today for a free consultation.