When a surrogate is pregnant, she will need her own health insurance or obtain a health insurance policy 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 if needed who specializes in the field of insurance in assisted reproductive technology journeys. We at CFC are not insurance experts and cannot tell you what to do in selecting a policy, but we will help coordinate your communication with insurance experts who are best suited to provide you with guidance and assistance as a third party.
If a surrogate has insurance of her own, we will send the policy to the insurance experts for a thorough review. They will advise as to whether the own existing policy is likely to be usable for a surrogate pregnancy. Backup policies are often recommended as well.
If a surrogate’s health insurance is not “surrogacy-friendly,” or if a surrogate does not have insurance at all, the insurance experts, ART Risk, will recommend that an insurance policy be purchased through the ACA to cover the pregnancy care. In this case, intended parents often will pay the premiums for the duration of the surrogacy journey and several months after the delivery for postpartum care.
Insurance policy terms can change at any time without necessarily notifying the policy holder. This is why we work with a surrogacy insurance expert to check the most recent policy booklets regularly to check if terms have changed. A policy that was previously “surrogacy-friendly” may decide to add an explicit exclusion or financial lien on the policy connected to a surrogacy journey. It is also possible for a surrogate or her spouse to lose employment, and thus their primary insurance policy. In many cases, it is possible to obtain an ACA policy outside of the standard open enrollment period, especially if there is loss of insurance. In the rare event that a surrogacy-friendly policy were not available in unique circumstances, there are other options as well to help protect the financial costs for the intended parents. We have helped coordinate insurance and loss of insurance for surrogates for many years, and would work with you, your surrogate, and insurance experts to find the best solution.
The cost to cover a surrogate’s pregnancy and delivery expenses will vary from case to case, based on the terms of the particular insurance policy and in-network medical providers.
EXAMPLE 1:
“Katie” has private insurance through her employer, and the insurance experts deem the policy likely to be usable for surrogacy based on the full plan document terms and expert knowledge of insurance and surrogacy. As with most “self-funded” policies through employers, the insurance experts advise having a backup insurance policy. The cost for a backup policy is approximately $3,000 unless it becomes necessary to activate it, in which case it becomes very expensive, but still reduces the cost responsibility from an intended parent perspective.
For this example, let’s assume the following:
In this particular case, Katie’s “surrogacy-friendly” insurance would end up costing her intended parents around $9,000 assuming all care fell within one calendar year. (It is important to note that a deductible starts over each calendar year, oftentimes in January, but sometimes during other months depending on the policy’s effective date.) 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.
Katie would receive the full base compensation regardless of the status of her insurance.
In the unlikely event that Katie’s insurance is denied during the surrogacy and the backup policy needs to be activated, the cost for the backup policy would then be over $25,000 to cover the pregnancy and delivery. It is extremely rare for a case to need to activate a backup policy, but with insurance, there are no guarantees and it is important to defer to insurance experts for a backup plan.
The option likely still exists for surrogates to enroll in an ACA-compliant policy through the marketplace during the open enrollment period in the fall. These ACA policies then become active in January, March, or February at the start of the year. It is also possible to obtain an ACA policy during special enrollment periods if certain criteria apply. Not every county in the U.S. has a surrogacy-friendly policy available, so it is important to rely on surrogacy insurance experts, like ART Risk or New Life, for their recommendations. We do assist with this coordination.
ACA policies range greatly in cost, but, on average, a typical ACA policy might have monthly premiums of $600 to $900 or more per month. Generally, the lower the premium, the higher the yearly deductible, and vice versa. It is recommended to also consider a policy in terms of co-insurance amounts, co-pays (for OBGYN and/or MFM appointments), and emergency room visit costs.
Insurance experts can also assist you in obtaining a newborn insurance policy or adding a dependent to your insurance policy. A surrogate’s insurance only covers her pregnancy and postpartum care, not the cost of newborn baby healthcare or pediatrician visits.
At Creative Family Connections, we do not employ insurance experts. While our team is very knowledgeable about potential insurance options during a surrogate journey and insurance solutions through past cases, we will coordinate with insurance experts who can walk you through the options available for your particular journey or situation.