Maternity Coverage

Maternity Coverage in Colorado

All 6 of the Anthem Blue Cross Blue Shield plans that are offered in Colorado include maternity coverage.  Pre-existing condition limitations effect maternity coverage for individuals age 19 or older.  For members age 19 or older, a pre-existing condition is an injury, sickness, or pregnancy for which a person incurred charges, received medical treatment, consulted a health-care professional, or took prescription drugs within 12 months immediately preceding the effective date of coverage.

The period during which pre-existing conditions like pregnancy are not covered is defined as: “12 months for all pre-existing conditions unless the covered person is a HIPAA-eligible individual as defined under federal and state law or under age 19, in which case there are no pre-existing condition exclusions.”

All plans in Colorado cover maternity expenses, according to the plan limitations, just as they would any sickness.  Pre-existing condition limitations affect maternity coverage for individuals age 19 or older.  For members age 19 or older, a pre-existing condition is an injury, sickness, or pregnancy for which a person incurred charges, received medical treatment, consulted a health-care professional, or took prescription drugs within 12 months immediately preceding the effective date of coverage.

Blue Cross Blue Shield Plans with Maternity Coverage at a Glance:

Remember that all plans include maternity coverage.  The most popular carrier among our clients wanting maternity coverage is Anthem Blue Cross Blue Shield.  Here are the details of how their plans work.

Anthem Premier has 25% co-insurance on in-network prenatal care, delivery and inpatient well baby care after the deductible has been met...

Prenatal care, delivery and inpatient well baby care from out-of-network providers has 50% co-insurance after the deductible has been met, plus all charges in excess of the maximum allowed amount, which depends on the exact type of service.

ClearProtection has both an inpatient surgical/hospital deductible and an outpatient professional services deductible.  Inpatient prenatal care services with in-network providers have30% co-insurance after the deductible has been met.  Outpatient prenatal care services with in-network providers have0% co-insurance after the deductible has been met.

Inpatient and outpatient prenatal care services with out-of-network providers have 50% co-insurance after the respective deductible has been met, plus all charges in excess of the maximum allowed amount, which depends on the exact type of service.

In-network delivery and inpatient well baby care has 30% co-insurance after the deductible has been met.

Out-of-network delivery and inpatient well baby care has 50% co-insurance after the deductible has been met, plus all charges in excess of the maximum allowed amount, which depends on the exact type of service.

CoreShare Plus has prenatal care for $750, $1,500, $2,500, $3,500, $5,000 and $7,500 plans that have 50% co-insurance for in-network provider services after the deductible has been met.  These plans have 70% co-insurance on out-of-network provider services after the deductible has been met, plus all charges in excess of the maximum allowed amount, which depends on the exact type of service.

The prenatal care $10,000, $15,000 and $25,000 plans have 0% co-insurance for in-network provider services after the deductible has been met.  These plans have 30% co-insurance on out-of-network provider services after the deductible has been met, plus all charges in excess of the maximum allowed amount, which depends on the exact type of service.

On delivery and inpatient well baby care, the $750, $1,500, $2,500, $3,500, $5,000 and $7,500 plans have 50% co-insurance for in-network provider services after the deductible has been met.  These plans have 70% co-insurance on out-of-network provider services after the deductible has been met, plus all charges in excess of the maximum allowed amount, which depends on the exact type of service.

On delivery and inpatient well baby care, the $10,000, $15,000 and $25,000 plans have 0% co-insurance for in-network provider services after the deductible has been met.  These plans have 30% co-insurance on out-of-network provider services after the deductible has been met, plus all charges in excess of the maximum allowed amount, which depends on the exact type of service.

Lumenos HSA covers prenatal, delivery and inpatient well baby care from in-network providers with $0 co-insurance after the deductible has been met.  It also covers prenatal, delivery and inpatient well baby care from out-of-network providers with 40% co-insurance after the deductible has been met, plus all charges in excess of the maximum allowed amount,which depends on the exact type of service.

SmartSense Plus covers prenatal, delivery and inpatient well baby care from in-network providers with 30% co-insurance after the deductible has been met.  It also covers prenatal, delivery and inpatient well baby care from out-of-network providers with 50% co-insurance after the deductible has been met, plus all charges in excess of the maximum allowed amount,which depends on the exact type of service.

Tonik 5000 covers prenatal care from in-network providers with no co-payment; 100% covered after the deductible has been met.  Prenatal care from out-of-network providers has 40% co-insurance after the deductible has been met.

Delivery and inpatient well baby care from in-network providers is covered with no co-payment; 100% covered after the deductible has been met for inpatient well baby care for 31 days following birth, adoption or placement for adoption.

Delivery and inpatient well baby care from out-of-network providers has 40% co-insurance after the deductible has been met for inpatient well baby care for 31 days following birth, adoption or placement for adoption.