The insurance industry in the United States is as complex as it gets in relation to the process, as it is a far cry from what we are used to seeing in Europe.
With respect to surrogates, there are different options that we can find:
1. That the surrogate mother has an insurance that covers medical expenses related to a surrogacy process: This insurance may be through her employer, her partner’s employer, or she or her agency may have contracted it. In these cases, when monthly premiums are paid by the pregnant woman or the agency, the premiums will be charged to the intended parents upon matching. When premium payments are made by an employer, expectant parents usually have an extra line item in their benefit package.
2. If the surrogate has an insurance that does not cover medical expenses related to a surrogacy process or does not have any insurance at all: In these cases, a new insurance must be taken out during the “open enrollment” period.
What is the “open enrollment” period?
In the United States there is only one specific period per year to be able to take out health insurance known as “Obama Care” insurance. These insurances are the most affordable in the U.S. and with a very broad coverage. We will always prioritize the contracting of these insurances over any other existing private insurance.
The period for contracting this insurance is known as “open enrollment” and usually runs from October to December (there may be slight variations from state to state and from year to year). Only during this period will it be possible to take out health insurance that will become active in January of the following year.
What happens if I am paired with a pregnant woman who does not have insurance and it is March, for example?
Unfortunately, in such cases we can only opt for other types of more expensive private policies with less coverage or contract an intermediate plan until we reach the next “open enrollment” period.
How do the “Obama Care” insurance policies work once they are contracted?
Generally speaking, we can say that the policies work as follows:
a. Monthly premiums: Monthly cost paid for the pregnant woman to have health coverage.
b. Excess: Amount to be paid before all medical expenses are absorbed by the insurance. Let’s imagine that we have a franchise of $8,000. This is divided into:
i. Deductible: Portion of the deductible that will be paid in full. Let’s assume that of the total deductible of $8,000, the deductible is $2,000. This means that up to $2,000 will pay in full any bill when the pregnant woman goes to the doctor up to $2,000.
ii. Copayments: Once the deductible amount is reached, copayments apply. This means that each time the pregnant woman goes to the doctor, she will have to pay a percentage of the visit or a fixed amount. It will depend on the insurance and the service needed. All bills will be paid in co-payments up to point iii.
iii. Out of pocket max: This is the maximum amount that can be paid in medical expenses within a calendar year and is the maximum deductible. That is, in this case $8,000. Normally this figure is reached at delivery.
It should be remembered that insurance works on a calendar year basis. Therefore, the part of the deductible that has been paid in one year is not accumulated for the following year, but returns to 0. Also, the amount of premiums and deductibles are updated every year, so it is most likely that a pregnant woman in two different years her insurance costs will differ by several hundred dollars.
Is it possible to choose different types of insurance within the “Obama Care policies”?
Yes, there are different options among which the price of premiums and deductibles vary. Depending on the moment of the process in which you are, it will make more sense to contract a policy with a high premium and a low deductible or the other way around.
Can I use an “Obama Care policy” to cover the baby’s expenses?
Even though children born in the U.S. are Americans, they are not eligible for “Obama Care” policies, as they are only available to U.S. residents. In cases of surrogacy, children are not considered residents since their parents are not U.S. tax residents, which is a prerequisite to qualify for these policies. Contracting these insurance policies for minors is considered fraud.
Can my pregnant woman’s insurance cover my child’s expenses?
No. Generally speaking, insurance policies taken out for pregnant women can absorb the costs of a newborn if we add the newborn to their policy. In fact, many hospitals make the mistake of including the costs of the newborn in the insurance of the pregnant woman. However, as soon as it is reviewed that it is a surrogacy case they refuse to pay the pending charges for the child. We must prevent this from happening because at the moment they reject the charges we have already lost the option of discounts for prompt payment.
The costs of the child should never be absorbed by the insurance of the pregnant woman, since she is not the mother and, therefore, the baby cannot be covered by her insurance.
