Reprinted from the Health District's quarterly publication mailed to district residents (Spring 2001)

When women walk into Tom Francis' office and inquire about maternal insurance, he makes it clear it should be her last resort.

"I ask them if there's any way they could possibly get on a group plan," says Francis, a salesman with Health Insurance Benefits. "I ask if there's someone's plan they can get on and suggest they consider getting a job. 

"I urge them to do whatever it takes."

That's because he knows how much better coverage you can expect from a group plan when you're expecting. 

State law mandates group health insurance plans to provide maternal coverage. 

"The ruling was a civil rights issue," says Susan Gambrill, special assistant to the state insurance commissioner. "To not provide maternity coverage to a woman would be discrimination on the basis of sex.

"Coverage for pregnancy must be equivalent to coverage of any illness."
Individual policies can have maternity riders attached to them, but the riders usually have a substantial increase in premium. 

For example, a woman of childbearing age would pay about $91 a month for health insurance through National Travelers Life Company without maternity coverage. With maternity coverage, that premium jumps to $162 per month.

There are a few maternal policies available as supplemental insurance, but they're very expensive. Francis offers one policy that is $30 a month for $1,000 in benefits. 

Conversely, many group plans’ maternity benefits are so extensive that a new mother will only pay a fraction of the costs of having her baby. 

A normal delivery at Poudre Valley Hospital cost just over $3,000 last year. Depending on insurance and the healthcare provider, women may be responsible for as little as $100-200 of that amount. 

But just because a woman is covered by her employer's health plan doesn't necessarily mean she's covered for maternity. There's an exception to the mandate that expectant mothers need to watch out for, according to Gambrill.

"Many larger companies are self-funded," she says. "If they have taken on the insurance risk then they aren't subject to state laws.

"People need to inform themselves by checking their policies and asking questions."

While reviewing a policy, expectant mothers should check for what exactly will be covered during their delivery. If there is a predetermined flat rate, it may not include complications. On individual policies there might be a deductible to be met. In the earlier mentioned individual policy, for example, there is a $1,000 deductible at the time of delivery.

One final note: under Colorado law new mothers are allowed a 48-hour hospital stay for a normal delivery and a 96-hour stay for a caesarean section birth.