Health sharing plans, also known as medical cost-sharing programs, have emerged as an affordable alternative to traditional health insurance. Learn how maternity works with health share plans.
These plans function based on members making monthly contributions to a collective fund, which is then utilized to handle eligible medical expenses for members. While health sharing plans can provide substantial cost savings, it is essential to comprehend their approach to maternity benefits, as the policies and benefits can differ greatly among various providers.
Exploring Maternity Benefits in Health Share Plans
Unlike traditional health insurance plans, which must include maternity care as a mandatory benefit, health share plans can set their own rules regarding what they support, often having various restrictions and requirements compared to traditional health insurance.
Many plans mandate that members be married to qualify for maternity benefits. Additionally, some health sharing ministries require a statement of faith or adherence to certain principles as a condition of membership.
Some of these plans might not support maternity care at all, while others may offer it under certain conditions or with extra fees. It’s crucial to thoroughly examine the guidelines and policies of the plan before joining, particularly if you are considering having children.
Waiting Periods and Pre-Existing Conditions
Many health share plans impose waiting periods, which can range from 60 days to a year or more after joining, before maternity-related expenses are eligible for sharing.
Additionally, some plans may consider pregnancy a pre-existing condition if it occurred before joining the plan or during the waiting period, potentially delaying eligibility for maternity cost sharing until one or two years after enrollment.
For example, certain plans require members to be enrolled for at least 12 months prior to their projected due date for maternity costs to be shared, and similar waiting periods typically apply to pre-existing conditions.
Out-of-Pocket Costs and Sharing Limits
Even when maternity benefits are included, health share plans often require members to pay higher out-of-pocket costs for maternity-related expenses.
For example, some plans may double the standard initial unshared amount (IUA) or deductible for maternity claims. This means that members must pay a higher portion of the costs before the plan starts sharing expenses.
Furthermore, some health share plans may have annual or lifetime sharing limits, which cap the total amount the plan will contribute towards medical expenses. These limits can range from a few hundred thousand dollars to unlimited sharing, depending on the plan and membership tier.
It’s crucial to understand these limits and how they may impact your maternity costs.
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Top Health Share Plans for Maternity Benefits
While maternity benefit policies vary, some health share plans are notable for their extensive maternity support.
Here are a few examples:
Altrua Healthshare
Altrua provides maternity benefits for eligible memberships (Secure, Care+) following a 60-day waiting period. Members must pay twice the standard IUA before maternity expenses are shared, and there is no annual limit on sharing.
Sedera
Sedera provides maternity benefits for all membership levels after a 12-month waiting period. Members are responsible for the standard IUA, and there is no annual sharing limit. Sedera also offers discounts for home births or birthing centers.
Health Share Plans with Limited Maternity Benefits
While some plans offer comprehensive maternity benefits, others may have more restrictions or limitations. For example:
Medi-Share
Medi-Share, a Christian-based health share plan, has a 12-month waiting period for maternity benefits and a $125,000 sharing limit per pregnancy. Members are responsible for the standard IUA and any additional costs beyond the sharing limit.
JHS Community
JHS Community is a more affordable, catastrophic-only plan that does not cover maternity expenses or routine care. It is designed to provide protection against major medical events and hospitalizations.
Considerations for Choosing a Health Share Plan for Maternity
When choosing a health share plan for maternity benefits, it’s crucial to evaluate several key factors:
- Waiting Periods. Assess the waiting period for maternity benefits and make sure it matches your family planning schedule.
- Out-of-Pocket Costs. Understand the out-of-pocket costs, such as the IUA or deductible, and whether they are higher for maternity expenses.
- Sharing Limits. Review the annual and lifetime sharing limits to ensure they adequately meet your expected maternity expenses.
- Provider Networks. Some health share plans may have limited provider networks or require members to use specific facilities for maternity care.
- Additional Benefits. Consider whether the plan offers additional benefits, such as discounts for home births or birthing centers, which can further reduce costs.
It’s also essential to carefully read and understand the plan’s guidelines, restrictions, and statement of beliefs or principles, as these can vary among different health share plans.
Exploring Health Share Plans for Maternity and Newborn Care
Health share plans offer an alternative to traditional health insurance by allowing members to share healthcare costs through a community-based approach.
These plans are often favored for maternity care due to their generally lower expenses compared to traditional health insurance.
However, it is essential for prospective parents to comprehend the details of how these plans manage maternity care, including benefits for newborns, costs associated with cesarean sections, and pre-existing conditions.
Pre-Existing Condition Waiting Periods for Newborns
Health share plans typically handle pre-existing conditions with specific waiting periods before costs related to these conditions are eligible for sharing.
For newborns, the approach can vary significantly between plans. Some plans may cover newborns immediately, while others may require the newborn to be enrolled in the plan from birth and may impose a waiting period similar to that applied to new members.
For example, some plans might not share costs related to pre-existing conditions of the newborn until after a certain period, which can range from a few months to several years, depending on the severity of the condition and the specific rules of the health share plan.
Health Sharing for C-Section Costs
The costs associated with c-sections are typically shared under health share plans, but the extent of sharing can depend on whether the c-section is deemed medically necessary.
For instance, some plans may have a fixed sharing limit for normal deliveries and higher limits for medically necessary c-sections.
For example, once your basic initial member responsibility amount is met, one plan might share costs up to $5,000 for a normal delivery or a non-medically necessary c-section and up to $8,000 for a medically necessary c-section. Additionally, if complications arise that threaten the health of the mother or child, the sharing limit can increase significantly, up to $50,000 in some cases.
Adding Your Newborn(s) To Your Health Sharing Plan
Once the baby is born, health share plans typically extend benefits to the newborn, but the specifics can vary.
Some plans may require the baby to be added to the plan immediately after birth to cover any postnatal care or complications. The benefits for the newborn often include hospital charges from the birth, pediatric care, and any treatments required for conditions identified at birth.
However, it’s important to note that if the newborn has conditions that could be considered pre-existing (i.e., conditions diagnosed before the baby is added to the plan), there might be a waiting period before these are eligible for sharing. Again, check your plan’s health sharing.
Support for Mothers After Childbirth
For the mother, benefits typically continue seamlessly post-delivery.
Health share plans generally cover postpartum care, which can include follow-up visits, postnatal care, and any complications arising from the delivery. The sharing of these costs is usually subject to the plan’s standard terms and conditions, such as the member’s out-of-pocket responsibility and any relevant waiting periods for specific conditions or treatments.
| Health Sharing Plan | Pros | Cons |
|---|---|---|
| netWell Healthshare | High $2 million lifetime cost-sharing limit (Elite+ plan) Innovative drug access program with hundreds of drugs available free Excellent maternity benefits Catastrophic “Advantage” membership tier dovetails well with direct primary care strategy Solid comprehensive option Great track record paying qualified sharing requests Can be used at any provider you choose Preventive Visit after 90 days, shareable up to $1500 yearly | No HSA-qualifying High Deductible Health Plan available Two-year restrictions on sharing of bills arising from treatment of pre-existing conditions |
| JHS Community | Low, affordable monthly contribution levels Powerful sharing capacity for catastrophic care needs Membership tiers offer flexibility in cost-sharing after meeting MRA | Not suitable for those seeking low member responsibility amounts More comprehensive health sharing plans might be needed for some members |
| OneShare Health | Offers relatively low monthly contributions, making it accessible for individuals looking for cost-effective healthcare sharing options. The OneShare Classic Crown program provides a high lifetime maximum of $1,000,000, which is substantial for covering major medical expenses. Includes a comprehensive telemedicine program, which also covers mental health support, providing convenient access to healthcare services from home. Offers additional perks such as dental discounts, diabetic care and supplies, and lab discounts, enhancing the overall value of the plan. | Has certain restrictions related to the inclusion of pre-existing conditions, which may not be suitable for individuals with ongoing health concerns. Uses the Multiplan/PHCS Network, which may limit the choice of doctors and hospitals compared to plans with broader network options. There is no option to pair this plan with a Health Savings Account (HSA), which could be a drawback for those looking to utilize HSA benefits. Members must sign a 'light' statement of faith, which might not be suitable for everyone, especially those who prefer a secular plan. |
| Prosper | Faith-based, non-denominational plan that does not require specific church membership or adherence to Trinitarian theology, making it accessible to a broader range of people. Relatively short 3-year waiting period before costs for pre-existing conditions become fully shareable, with phased-in sharing benefits starting after 12 months. Offers a review process that may waive the waiting period for pre-existing conditions if certain criteria are met. No cap on lifetime sharing benefits, unlike some other health sharing plans. Accepts smokers as provisional members, which is uncommon among health sharing plans. Streamlined fee and cost-sharing structure. | Not suitable for those with major pre-existing conditions requiring treatment within the first 3 years of membership due to the waiting period. Maternity sharing limits of $5,000 for normal delivery, $8,000 for medically necessary C-section, and $50,000 combined for complications, which may be lower than some other plans. Limited information available on specific plan details like member responsibility amounts (MRAs) and sharing limits for various services. |
| Sedera Health | Emphasizes a holistic approach to health. Provides extensive healthcare benefits and the opportunity to share medical costs with a community. Provides transparency and integrity in its operations. No network restrictions, allowing freedom to choose providers. Claims are processed smoothly and reimbursements are efficient. Provides preventive care benefits. Provides wellness resources to help members stay proactive about their health. Offers significant savings on premiums compared to traditional insurance. Suitable for self-employed individuals who do not qualify for Obamacare subsidies. Offers flexible plans for individuals, families, and small businesses. No specific annual or lifetime maximum limits, which can be beneficial for large medical needs. Members are seen as cash customers, potentially leading to discounts from providers | Not suitable for everyone, particularly those who may need more traditional insurance structures. Members are responsible for preventative care costs, except for certain high-cost routine diagnostic procedures. Large sharing needs might be constrained by the total available funds, potentially limiting support for costly treatments. There is no assurance of benefits since it relies on the total funds available and the number of shares in the Excess Needs Account. Information on the website may be out of date and is not guaranteed for accuracy |
| HSA Secure | Very affordable Plan members qualify to make pre-tax contributions to health savings accounts (HSAs), with no additional purchase necessary. does not restrict members to a specific network of healthcare providers, allowing them to choose their doctors, specialists, and facilities If the costs for a home birth are significantly lower than a hospital birth, Zion HealthShare may partially waive the IUA for the maternity need. Provides a dedicated Maternity Support Team to assist members with medical bills, itemized bill requests, and navigating the maternity care process | Only available to business owners and those with verifiable income from independent contracting or self-employment. Maternity benefits are not shareable if conception occurs before the membership start date or within the first 60 days of membership. Medical records are used to confirm the conception date. |
| Universal Healthshare | Lower monthly contributions compared to typical health insurance premiums (up to 40% less) Offers over 20 different health cost sharing programs to choose from Provides options for both in-network and out-of-network providers Includes access to telemedicine services Offers a $5 co-share per prescription through RxSimpleShare™ Provides no-cost access to the UHF/Curam Wellness Center™ for various services Faith-based and inclusive, built on ethical, spiritual, and religious beliefs Embraces the concept of community aid and sharing of burdens Has been around for over 30 years, with over 2 million members Can be an affordable option for individuals, families, and small businesses | Not a traditional health insurance plan, but rather a health care cost sharing program The website does not clearly outline specific details, exclusions, and limitations related to the policy. Acceptance into the program requires agreeing to their Statement of Shared Faith and Beliefs Pre-existing conditions may be subject to limitations or exclusions (details not provided). No clear information on deductibles, out-of-pocket maximums, or cost-sharing responsibilities Limited information on the specific services covered under the different program options. |
| Altrua HealthShare | Options to suit different needs and budgets. Flexible pricing options. High lifetime limit available. Comprehensive coverage including preventive services. Helps reduce out-of-pocket costs for other health needs. Nationwide availability. Allows eventual sharing of costs for pre-existing conditions. | Varying limits and benefits might be confusing. Higher plans can be expensive for some budgets. Annual limits could be quickly reached with serious illnesses. Some services have additional requirements or limits. Discounts may not be sufficient for all members' needs. Not all services are available in every location. Initial waiting period can be a significant drawback. |
| Medi-Share | Aligns with Christian values. Encourages community support. Can be less expensive than traditional health insurance. Offers discounts on medical bills. Comprehensive coverage options. Access to 1M+ providers nationwide. Flexible options to fit different budgets. No minimum bill submissions. Convenient access to healthcare services. Encourages healthy lifestyles with incentives. | Not insurance; sharing of medical bills is voluntary. Availability of funds is not guaranteed. Members are personally responsible for the payment of their own medical bills in the absence of sharing. Some limitations on sharing for pre-existing conditions and certain services. Higher AHP means more out-of-pocket expenses before sharing starts. Some services might require pre-notification. |
| Care+ | Nearly identical to HSA Secure, above, except: 1.) It is open to all applicants, and not just business owners and the self-employed/independent contractors, and; 2.) Members are not automatically eligible to contribute to HSAs. However, those who are business owners or have independent contracting or self-employment income can purchase HSA MEC, an affordable low-premium preventive health plan that will render members eligible to contribute to HSAs. | Maternity benefits are not shareable if conception occurs before the membership start date or within the first 60 days of membership. Medical records are used to confirm the conception date. |
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Conclusion
Maternity benefits vary significantly across different health share plans, with each offering distinct features such as waiting periods, out-of-pocket responsibilities, and sharing limits.
Plans like MediShare, Altrua, and netWell provide various levels of support for maternity expenses, tailored to meet different needs and budgets.
To navigate these options and select a health share plan that best fits your specific healthcare needs, consider consulting with one of our Personal Benefits Managers. These experts provide free, personalized guidance to help you make an informed decision about your health share plan selection.
For Further Reading: The 5 Best Health Sharing Plans for 2024 | How To Pay for Pregnancy and Childbirth Expenses | 2024 Complete Guide to Small Business Healthcare Plans
