H.H from Chico gave birth to her first child two years ago and unfortunately, she was underinsured.
Even though she had access to purchase an Affordable Care Act (ACA) plan, she remained on her grandfathered policy that she purchased back in 2006. She was misinformed by the level of coverage of her pregnancy, and this is why she did not transition to an ACA qualified plan. The grandfathered policy covered complications from birth only.
Therefore, H.H was financially responsible for pre-natal care, birth of the child, and the post-natal care.
Due to this not being covered, she did not have a stop loss for the global billing. In California, the cost of a non-complicated vaginal birth ranges from $15,204 to $28,541, depending on the city of birth.
H.H came to our firm mid-December of 2016. She was four months pregnant with her second child. We enrolled her in a qualified health plan under the Affordable Care Act, which provides maternity coverage along with other essential health benefits. Prior to the enactment of the law, pregnancy was considered a pre-existing condition, and a mother could be denied an individual policy.
The ACA has allowed those with pre-existing conditions to enroll in a guaranteed issue plan during each open enrollment period or during a special enrollment period when a qualifying life event presents itself. Prior to the ACA, maternity coverage was a given when insured under an employer sponsored plan. It was rare to find an individual policy that had comprehensive maternity coverage.
By placing her with a Platinum level plan, her risk exposure for the calendar year is $4,000. After she reaches her out-of-pocket maximum, the carrier will pay 100% of the allowed amount for the remainder of the calendar year. Due to the Affordable Care Act, her level of coverage is appropriate for her medical needs.