Pregnancy benefits may be different in group and individual health plans.
If you have a group health plan, through your job:
Your group health plan must cover care for your pregnancy and delivery, whether you are pregnant when you join the plan or become pregnant after you join it.
If you have an individual health plan, that you buy on your own:
- If you are pregnant when you join an individual health plan, and you are 19 or older, the plan can say that this pregnancy is a pre-existing condition. If the plan has an exclusion period for pre-existing conditions, care for this pregnancy and delivery will not be covered. However, your plan may cover some complications of pregnancy, such as gestational diabetes or high blood pressure.
- If you are pregnant when you join an individual health plan and you are under age 19, the plan must cover care for your pregnancy and delivery.
Choosing an Obstetrician and Hospital
An obstetrician is a doctor who specializes in pregnancy and delivery.
- You can see an obstetrician in your health plan's network without a referral.
- When you choose an obstetrician, ask which network hospital you will go to for the birth.
- The law protects your right to continuity of care during your pregnancy. This means that if your doctor leaves your plan after you are 6 months pregnant, you can usually see the same doctor until after the birth. Check with your plan.
- Ask your doctor or health plan about classes on childbirth, breastfeeding, nutrition, and exercise during pregnancy.
- By law, health plans must cover at least 2 days in the hospital after a vaginal delivery and 4 days after a delivery by C-section.
Make Sure to Enroll Your Baby in Your Plan
There are time limits on when you can enroll your baby in your plan. If you have a baby or adopt a child, ask your health plan or your employer right away about when to add your new baby or child to your health plan.
Low-cost health care program for low- to middle-income pregnant women and infants
1-800-433-2611 (many languages)
Health care program for people who qualify because of low incomes, or disabilities
Information on children's health
National Hispanic Prenatal Helpline
Información sobre el embarazo, parto y el cuidado de los infants
Information about pregnancy, birth, and child care