Parents' insurance covers children up to age 26 — but not for pregnancy - Washington Post

The health-care overhaul provides a safety net for young adult children, who can now stay on their parents’ health plans until they reach age 26. But it doesn’t guarantee that their parents’ plan will cover a common medical condition that many young women face: pregnancy.

Group health plans with 15 or more workers are required to provide maternity benefits for employees and their spouses under the Pregnancy Discrimination Act of 1978. But other dependents of employees aren’t covered by the law, so companies don’t have to provide maternity coverage for them.

(iStock) - Health insurers must cover members’ children until age 26, but this rule does not include pregnancy.

Although hard numbers aren’t available on how many companies don’t provide dependent maternity benefits, “I would say it’s common,” says Dania Palanker, a senior health policy adviser at the National Women’s Law Center. And the number could grow with the recent expansion of coverage to children under age 26, she says.

Dan Priga, who heads the performance audit group for Mercer, a human resources consulting company, estimates that roughly 70 percent of companies that pay their employees’ health-care claims directly choose not to provide dependent maternity benefits.

In 2008, an estimated 2.8 million women ages 15 through 25 got pregnant, 12 percent of all those in this age group, according to researchers at the National Center for Health Statistics. (That is the most recent year for which there are pregnancy estimates.)

An unwelcome surprise

When Wendy Kline learned this spring that her 17-year-old daughter was four months pregnant, she took her to the doctor for prenatal care. Her insurer denied the claim, citing her employer’s policy not to cover maternity care for dependents.

“At that point my jaw hit the floor, because I did not know how we were going to pay for this,” Kline says.

Kline asked her company, a medical equipment retailer in Martinsburg, W.Va., to change its policy. But company officials turned the 26-year veteran employee down.

“You work all your life and pay these insurance premiums,” she says. “Then you ask for help and can’t get any. It’s just so unfair.”

In some states, a pregnant young woman might qualify for Medicaid, the federal-state health-care program for low-income individuals, even if she lived at home with her parents, say experts. But when Wendy and her husband, Andy, investigated, they were told that eligibility would be based on their household income, which was too high to qualify for Medicaid.

So far, their daughter’s pregnancy has been uneventful, and doctor visits and lab work have totaled $300. But the Klines know the big bills are yet to come. Andy recently took out a $2,000 loan from his 401(k) to put toward the hospital bill. It’s a start.

According to the March of Dimes, the average cost for uncomplicated maternity care was $10,652 in 2007. That includes prenatal care, a routine delivery and three months postpartum care.

In 2010, researchers at the Center for Business and Economic Research at Marshall University in Huntington, W.Va., published a report that analyzed the costs associated with providing mandatory maternity coverage for dependent minors in West Virginia.