GC INSURANCE FOR PREGNANCY & DELIVERY
When your surrogate is pregnant, she will need her own insurance to cover the pregnancy and delivery. It is part of our due diligence during the pre-screening process to connect you with an insurance agency who specializes in the field of assisted reproductive technology insurance. We at CFC are not insurance experts and cannot tell you what to do in regard to selecting a policy for your surrogate, but we will help coordinate your communication with insurance experts who are better suited to provide you with guidance and assistance. They are not our subcontractors, and they will work directly for you.
If your surrogate has insurance of her own, we will send her policy to the insurance experts for a review. They will advise as to whether her own existing policy is likely to be usable for a surrogacy, and will likely recommend a backup policy. In such a case, the GC will receive the full base rate for her state of residency, and will continue to pay her own premiums.
If her insurance is not usable, or should she not have insurance at all, the insurance experts will recommend that you purchase a private insurance policy to cover the pregnancy. In this case, you will pay the premiums, but your GC’s base fee will be reduced by $5,000 to help offset the expense.
GC INSURANCE COSTS:
The cost to cover your GC’s pregnancy and delivery expenses will vary from case to case, based on the terms of her particular insurance policy. That said, we are able to provide some examples of typical cases that we might encounter in theory:
“Sue” has private insurance policies through her employer that covers pregnancy, and the insurance experts deem her policy likely to be usable for surrogacy. As with most self-funded policies, the insurance experts advise that a backup insurance policy be purchased by her IPs. The cost for a backup policy is approximately $3,000.
For this example, let’s assume the following:
- Sue’s policy has a deductible of $5,000.
- Co-pays and miscellaneous non-covered expenses will total ~$1,000 over the course of the journey.
In this particular case, Sue’s usable insurance would end up costing her IPs around $9,000. If her deductible was substantially higher or lower, the total would adjust accordingly. i.e., if her policy had a $2,500 deductible, her usable insurance would end up costing her IPs around $6,500. If she had a $10,000 deductible, her insurance would end up costing her IPs around $14,000.
Sue would receive the full base amount for her state of residency, because her existing insurance is usable.
In the unlikely event that Sue’s insurance is denied during the surrogacy and the backup policy has to be activated, the cost for the backup policy would then be around $25,000 to cover the pregnancy. We have never had a Client who has needed to activate a backup policy, but insurance is always changing, and there are never any guarantees.
“Sue” has private insurance that the experts determine is not usable for surrogacy. Her IPs must then decide on an outside policy to purchase for Sue.
For all of the options listed below, Sue’s base rate would be reduced by $5,000 because she does not have usable insurance.
PregnancyCare: The newest option on the market, PregnancyCare, was specifically created to cover gestational surrogacy but would also work as a typical health insurance plan. Premiums are $1,350 per month if enrolled prior to embryo transfer, and the enrollment fee is $500. PregnancyCare would activate starting at the signing of the GC Contract, and has a minimum requirement to continue until 3 months after delivery.
If enrollment occurs post-embryo transfer through 12-weeks of pregnancy, premiums are $2,200 per month.
100% coverage for Gestational Surrogacy (Please note: Genetic testing requires preauthorization, and is approved if a doctor deems it “medically necessary”)
Coverage for major medical
No deductible, no co-pays, and no co-insurance
No lifetime maximum plan benefit
Network of providers in all 50 states
Out-of-network providers ok with pre-approval
All forms of payment accepted
Easy enrollment and fast approval
A United Family (UFI) policy is another option for GC pregnancy coverage. The enrollment fee is $3,000. The premiums total $10,350. There is a $15,000 deductible, bringing the total cost to $28,350 for the standard plan. (GCs meeting certain criteria may qualify for the premium plan, which is about $3,000 less.)
No network – open to all providers
Up to six medically necessary ultrasounds per child
Maximum allowance of $500,000 per GC, per pregnancy
Does not include coverage for major medical
There are benefits and drawbacks to both of the above-named policies. PRIME includes coverage for major medical and has no lifetime maximum allowance. However, the total amount due for PRIME coverage is open-ended, since it continues at $1,050 per month until 3 months post-delivery, regardless of medical delays, etc. On the other hand, UFI does not include major medical coverage and has a lifetime allowance cap. But, unlike PRIME, the total cost per pregnancy with UFI is locked in, regardless of the timeline.
ACA-COMPLIANT POLICY DURING OPEN ENROLLMENT:
The option may still exist for GCs to enroll in an ACA-compliant policy through the Marketplace during the open enrollment period in the fall. This strategy, however, is subject to ongoing shifts in the US insurance Marketplace following the change in Administrations.
ACA policies range in cost, but, on average, a typical ACA policy might have premiums of $700 per month, and a $5,000 deductible. For 15 months, premiums would total $7,500, plus the cost of a backup policy ($3000) plus the deductible of $5,000. In such a case, the ACA policy would end up costing around $15,500 for a typical journey.
Uncertainty in the Marketplace guarantees that a backup policy will be indicated if this option is selected, as no one can guarantee how the US insurance market will change and shift in the coming months.
CFC does not employ insurance experts, and our team does represent themselves as such. We will put you in touch with insurance experts who can walk you through the options available for your particular case. Only you can decide which option is right for your case.