Individual health insurance plans lack standard maternity coverage

NEW YORK -- Although Deborah Beck has no immediate plans to have a baby, she'd still feel better knowing her health insurance covers pregnancy -- just in case.

Beck was stunned last month when she discovered that her new policy lacked maternity coverage. CareFirst Blue Cross and Blue Shield, a Washington, D.C.-area health plan, told Beck she could have maternity coverage, but it would increase the cost of her policy from $138 a month to $264 a month.

Beck, 27, a political consultant in Washington, D.C. reluctantly declined the coverage because of the price.

But "it will be in the back of my mind," she said. "I know it will be an extra consequence if I do get pregnant."

Across the United States, thousands of women like Beck who buy health insurance on their own -- rather than obtaining it through employers -- are forced to pay significantly higher premiums to receive maternity benefits, according to government and privately financed reports.

The reason: Individually sold plans often don't include maternity as a standard benefit.

Women and consumer groups contend the lack of maternity coverage is unfair and discriminatory. And, they say, while society urges pregnant women to avoid smoking and drinking and other unhealthy behaviors, the lack of insurance coverage creates a barrier to women getting prenatal care to help prevent birth defects and other complications.

"Women have different care needs than men and for a health plan not to cover maternity is a form of discrimination against women," said Joanne Hustead, director of legal and public policy for the Washington-based National Partnership for Women and Families.

A 1997 General Accounting Office study of individual health insurance market in seven states found that maternity services were covered only by about 60 percent of health plans. A 1998 study by the Alpha Center, an independent health research organization, found the situation even worse in a report on the individual market in 10 states.

"Insurers generally exclude normal maternity benefits from their standard policy and offer maternity coverage as a separate rider, but some exclude maternity benefits entirely," the report stated.

The monthly cost of supplemental maternity coverage ranged from $75 to $100. The maternity coverage also included additional copayments and deductibles not required for standard benefits, the report found.

Insurers defend their decision to not include maternity coverage as a basic benefit, saying that having a baby is a planned event, and that insurance is designed to cover the unexpected.

Moreover, insurers say, making maternity an optional benefit helps keep their costs down and keep premiums reasonable for women not planning to give birth. If they are forced to cover maternity, insurers say, it will push premiums higher and cause more people to become uninsured.

"We offer a variety of policies because people want choices," said Susan Laudicina, director of research for the Washington-based Blue Cross and Blue Shield Association. "If you want it, you pay more for it," she said.

Critics dismiss both arguments. Responding to the argument that pregnancy is a planned event, they note the high rate of unplanned pregnancies in this country. Furthermore, women's groups say, if insurers can exclude maternity as a basic benefit, why not give young adults optional coverage for prostate cancer or Alzheimer's disease?

"Their argument is inconsistent with the notion of insurance," Hustead said.