Virginia maternity insurance is generally a covered benefit under most group health insurance policies, but the story is very different on the individual health insurance market. In fact, most companies will not cover any claims for office visits and hospitalization for pregnancies, except for complications of birth.
The only major two carriers that offer full maternity coverage on the Virginia health insurance market are Anthem and CareFirst – both of which are part of the Blue Cross/Blue Shield network of companies. Your zip code will determine which company you can apply with. If you are east of Route 123 in Northern Virginia, only Care First is available. Anywhere west of Route 123 (which covers ~90% of Virginia) would mean you are eligible with Anthem. CareFirst is also available in all areas Washington DC and Maryland.
Anthem offers maternity benefits as an optional rider on their Anthem Premier and Anthem Lumenos HSA Plus plans, but only with deductibles of $2,500 or higher. Anthem does NOT offer maternity on their SmartSense, SmartSense with Enhanced Drugs, or CoreShare plans. A six-month waiting period from the policy’s effective date is required for claims to be covered, and the cost of the maternity benefit is $71.00 per month regardless of the deductible chosen. The Premier plan with a $2,500 deductible would offer the lowest “maximum out of pocket expense” for maternity.
CareFirst offers maternity benefits as a standard part of the policy on their CareFirst Healthy Blue Dual Option HSA plan and CareFirst HealthyBlue Triple Option plan. There is no waiting period, and maternity benefits are subject to the policy deductible. Since the HealthyBlue plans have a single combined deductible for the family, sometimes it can make sense to a husband/wife to apply for separate policies to minimize the total expenses (the deductible for an individual is half of the deductible for a couple). This would depend on rates, number of family members, and medical history. Please contact us for specifics on when to apply separately.
CareFirst also has maternity benefits as an optional rider on their BluePreferred PPO plans. The addition premium is $126 per month and there is a 10-month waiting period required before conception can occur to be covered. Click here to get instant CareFirst health insurance with maternity quotes and apply online.
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