Health Insurance And Surrogacy: How Does It Work?

Pregnancy is a wonderful experience for many couples looking to grow their family. Unfortunately, there are couples who want children but are unable to have them. Surrogacy is a pregnancy option for couples who are unable to conceive a child on their own. If you are considering surrogacy as an option, here are some common questions and answers that may help you obtain a firmer grasp of the intricacies.

What is a surrogate and surrogacy pregnancy?

A surrogate is a woman who gets pregnant, carries, and gives birth to a baby for someone else, often a couple who are unable to have children. A pregnancy carried out by a surrogate is considered a surrogacy pregnancy.

What types of surrogacy pregnancies exist?

There are two kinds of surrogacy pregnancies: traditional surrogacy and gestational surrogacy.

  • Traditional surrogacy involves a woman who gets artificially inseminated with the father’s sperm, then carries the baby and delivers it for the intended parents to raise. A traditional surrogate is the baby’s biological mother.
  • Gestational surrogacy involves a technique called “in vitro fertilization” (IVF). IVF makes it possible to gather eggs from the mother or egg donor, fertilize them with sperm from the father or sperm donor, and place the embryo into the uterus of a gestational surrogate. The surrogate then carries the baby until birth. They do not have genetic ties to the child because it was not their egg that was used. A gestational surrogate is called a birth mother. The biological mother is the woman whose egg was fertilized.

Why is surrogacy considered?

Surrogacy is considered for several reasons, including:

  • Medical problems associated with the uterus.
  • A hysterectomy has removed the uterus.
  • Conditions that make pregnancy impossible or risky, like heart disease.
  • Assisted reproduction techniques, like IVF, have failed.

Who are intended parents?

An intended parent is an individual or couple who cannot conceive on their own and choose surrogacy to build their family.

What is the Affordable Care Act, and will it provide reliable insurance for my surrogate?

The Affordable Care Act (ACA), also known as ObamaCare, is a law passed in 2010 to reduce the number of Americans without insurance. Private insurance companies are forced to cover certain medical conditions (including new pregnancies, among others). Uninsured people are advised to buy insurance through an online website during an Open Enrollment period every November. ACA insurance plans are typically much more affordable and offer greater benefits than other plans. Many ACA plans will cover a surrogacy pregnancy. You can only enroll in the insurance program during “Open Enrollment” in November and early December. The policy takes effect in January. The average ACA plan has a monthly premium of around 500 a month for someone in their 20s who does not smoke.

What types of Affordable Care Act surrogacy insurance are available or required?

There are no ACA medical plans that are designed to cover a woman for surrogacy. She will need to have a medical insurance plan that does not have an exclusion for her using the maternity benefit of the policy while acting as a surrogate.

Will the surrogate’s insurance cover the surrogacy pregnancy?

Possibly. The policies vary from company to company. Many insurance policies don’t include coverage for surrogate pregnancy. A surrogate’s insurance policy will often not cover a surrogate pregnancy. If your surrogacy pregnancy is allowed by an insurance policy, there may also be steep deductibles or copayments that you must pay from your pocket before the insurance will begin paying for procedures. There is no set rule when it comes to surrogacy insurance and whether the insurance company has to cover a surrogate pregnancy.

The issue of insurance for surrogacy is usually handled during the legal contract stage of your surrogacy process. The surrogacy professional will look over each party’s insurance policies to determine what costs will be covered. Then they determine what services may be covered by supplemental insurance policies and how much the intended parents will be required to pay out of pocket for medical costs.

It is important to speak to an attorney, your HR representative, or an insurance representative to understand the specifics of your surrogacy insurance plan.

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Will the child be covered under a surrogate’s medical policy?

The surrogate child is covered In Utero only. Once the child is born, they are not a dependent of the surrogate and will not be covered by her medical plan. Any expenses related to the IVF cycle are not covered under this plan. When the baby leaves the womb, the Intended parents become responsible for all medical costs.

What is Surrogate Maternity Liability Insurance?

A Surrogate Maternity Liability Insurance Plan insures the intended parents for their surrogates’ incurred medical expenses related to pregnancy, childbirth, and postpartum depression. If a Surrogate Maternity Liability Insurance policy is used, only the medical expenses related to the surrogate pregnancy can be processed through the plan. It cannot be used for other medical expenses unrelated to the pregnancy. It does not cover any costs related to the IVF cycle.
Only the surrogate and her pregnancy are covered under this plan. It will not cover the baby after birth. You’ll want to make sure that you notify your personal health insurance company to inform them of the coming birth. They will let you know what you need to do to have the baby covered at birth.

Do you need medical insurance for your US surrogate?

Yes. You need to ensure your surrogate is fully covered by health insurance that will cover her prenatal care and delivery.

How much does medical insurance for a surrogate cost?

Insurance available through ObamaCare (The Affordable Care Act) is required by law to include maternity care, which generally includes surrogacy. These policies cost $600 to $700 a month, depending on the terms. Policies outside of Open Enrollment on the open market range from $1000-1500 a month.

Medical insurance for a surrogate varies dramatically. A traditional plan under the Affordable Care Act can run between 11k and 13k. Out-of-network costs can raise this higher. Costs will be higher if a Surrogate Maternity Liability Insurance plan is purchased and used as primary coverage. This is only available for singleton or twin carries. Not available for triplet or higher order multiple pregnancies. Average costs for this plan range from 25,500 to 28350 for women carrying a single child. And 42.5k to 43,350 for women carrying a twin pregnancy.

Is surrogacy considered a qualifying event for an insurance plan outside of open enrollment?

No. The month for Employer plan open enrollment may vary based on the employer. The national Open enrollment for an Affordable Care Act plan takes place once per year beginning on November 1 and ending dec 15. Few states allow an extension of this enrollment timeline until January 15. Unless there is a qualifying event, like a job change, this enrollment period is the only time your surrogate can sign up for a new health insurance plan.

Will surrogacy insurance cover payments to the surrogate?

No. Medical insurance (including Lloyds’s policy) will only cover medical treatment and does not cover the surrogate’s compensation.

What does insurance usually cover with surrogacy?

  • Infertility Treatments. Some insurance companies will cover infertility treatments up to a certain amount. This insurance will not cover the surrogate’s medical expenses but will typically cover the costs incurred during in vitro fertilization to create embryos. Fifteen states have enacted laws requiring insurance coverage for infertility treatment. Whether that law is applicable to your insurance company will vary based on aspects like your employer plan, the company size of your employer, where your employer’s policy was written, and more. In states where infertility coverage is not mandated, whether you can receive any surrogacy insurance coverage for IVF and other infertility processes will vary from policy to policy. Typically, health insurance plans will cover infertility testing because it’s fairly inexpensive. Because IVF is more expensive than other infertility treatments. It may not be covered under the intended parents’ insurance plan. 15 states have laws requiring insurance companies to cover infertility treatments. About 12% of U.S. women of childbearing age have received medical treatment for infertility. Of these states, most do not include a basic IVF procedure in their required coverage. No state requires surrogacy procedures to be covered. Only a few insurers will do this voluntarily.
  • The surrogate’s pregnancy. Insurance companies have started writing policies that only cover a pregnancy within the family, not a surrogate pregnancy. Certain insurance companies include a specific clause in their plans that exclude medical coverage for surrogate pregnancies. If the insurance company does not specifically state this type of pregnancy will not be covered, they must, by law, cover the costs that they normally would if it were a traditional pregnancy. It will vary by insurance company whether or not they provide insurance for surrogacy. If not, intended parents may need to purchase supplemental coverage or cover surrogate pregnancy costs out of pocket.
  • Artificial insemination. Some private health insurance companies will cover the cost of artificial insemination if the surrogate is using a combination of her own eggs with the genetic father’s sperm.

Some health insurance companies will offer the option of adding a temporary policy to your plan to cover the costs of a surrogate, fertility treatments, and labor and delivery.

What will insurance NOT cover with a surrogacy pregnancy?

Generally not covered by insurance:

  • Embryo transfer. Cost of an embryo transfer to a surrogate or the stimulation and fertility treatments that go along with that.
  • Donated eggs. Some private health plans may offer female workers a benefit allowing them to retrieve and freeze eggs.
  • In Vitro Fertilization. Rarely do insurance providers cover in vitro fertilization procedures. Some will offer one IVF procedure as part of an infertility benefit, but this is usually quite limited.

In most cases with surrogate pregnancy, the parents of the child will cover the costs not taken by insurance.

What is supplemental insurance, and will it cover surrogacy?

Supplemental insurance is a plan that helps pay for healthcare costs that are not covered by a person’s regular health insurance plan. Supplemental insurance policies for surrogacy have premiums of around 10k, and deductibles can start at 15k for single-child pregnancy. ART Risk Financial and New Life Agency are popular choices for surrogacy insurance plans for both intended parents and surrogates. They are and cover the surrogate’s medical costs.

It may be possible to purchase an individual plan that covers the surrogate’s maternity care. These plans have no deductible and are mandated to cover preventative health screenings. They are not written specifically for surrogate pregnancies, so it’s important that intended parents and their professionals review the plans to make sure that a surrogate pregnancy is not excluded. Intended parents may also wish to lock into a secondary insurance policy in case their primary insurance provider refuses to pay at the end of pregnancy.

How to make surrogacy affordable?

It is a good idea to be prepared to pay extensive medical costs. Before you begin your surrogacy process, make sure you understand exactly what will and will not be covered by your insurance provider. Then budget and finance appropriately. You can consider loans, grants, fundraising and crowdfunding, and other methods of saving money. Some US health insurance policies cover fertility treatments, including one or more IVF cycles. No insurance will cover the cost of your surrogate’s fertility treatments or compensation. Once pregnant, the surrogate’s prenatal care is paid from a separate health insurance policy that the parents will buy for the surrogate.

Final Word

Surrogacy is a delicate, complicated medical and financial situation. It is vital for a surrogate’s personal policy to be carefully evaluated by a qualified insurance specialist with knowledge of the fertility industry to determine whether your surrogate’s personal policy is suitable for use for a surrogate maternity cycle. It is recommended that a surrogacy professional completes an insurance review and gets an interpretation of the policy in writing. It is best to speak to a surrogacy professional, a financial advisor, or an insurance broker at Bell & Associates Consulting Firm to find out what options are available and which plans best fit your situation. Many surrogacy agencies include an insurance review as a part of their screening services.


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