- Pregnancy
- Baby & Toddler
- Parents
- Getting Pregnant
- Baby Names
- Product Reviews
-
Registry
- Community
-
More
Want a personalized experience?
Download the free app
2nd Trimester
Insurance Question
This is probably a dumb question to most, but I am clueless on insurance and I am trying to figure out what my max out of pocket will be so I know what to put aside for FSA.
I am on my DH's insurance and it is just the two of us. Our plan out-of-pocket copayment limit is $1,500 single/$3,000 family and the deductible is $250 single/$500 family. My question is what is the max I will have to pay out for my prenatal/postnatal care? Since me and my DH are on the same plan, will I have to pay at the family rate? I'm not sure if the single rate means 'single person' or if it the rates for someone that doesn't have any dependents listed on their insurance with them.
This discussion has been closed.
Re: Insurance Question
Single means just one person...
Your out of pocket max is the single rate. If DH needed major surgery or something your combined out of pocket max would be the family rate.
Just remember that the second the baby is born, he/she is a new person and will have his/her own hospital fees. So your pre/postnatal care is based on a single, but the baby will have fees too.
Also, you need to look at when the insurance plan year ends. Mine is not based on the claendar year andswitches over in July. This will make a difference.
I suggest talking to your HR department with your questions.
Dx: PCOS and short luteal phase
18 cycles (3 with our RE) - Metformin + Clomid + HCG booster did the trick!
BFP #1 6/22/09 EDD: 3/2/10 DS born: 3/8/10
TTC #2 since Dec 2011
BFP #2 7/8/12 EDD: 3/18/12 M/C @ 9w1d: 8/16/12
Check with your insurance. Some will cover 'well babies' ie babies who do not require additional NICU care or non-routine testing at 100%. Other insurances (like mine) will charge the baby their own deductible/copay at birth.
For simplicity sake, I'm counting on hitting our family maximum because I've got 3 deductibles to pay and we're more likely to have some NICU time. If we don't hit it with the birth, there will be 9-10 months of baby visits, prescriptions, contacts, etc that will eat away at the money as well.
The way my insurance works is since DH and I are both on the plan we pay the family rate - regardless of if he has been to the dr for the year.
From my understanding of insurance if you have a family you pay the family deductible regardless if you're the only one receiving care. I'm on my DH's insurance and luckily we don't have a deductible we only have to pay $150 for the whole pregnancy and once LO arrives he/she is covered 100% and we don't have to pay extra. Insurance can be hard to understand at first especially if they have different % for every piece of care you recieve. Just contact your insurance to find out. Before I was on DH's insurance my insurance billed everything separately now I couldn't be happier with our insurance it's one copay for everything or everything else is covered.