Maternity Insurance and the Cost of Pregnancy: Fact and Fiction
If you are pregnant, are considering becoming pregnant, or have someone on your health insurance plan that is pregnant or will become pregnant and especially if you live in the state of Florida then this is “The Maternity Insurance Article” for you. The aim of this article is to explain some of the maternity options available to you and to debunk some common myths concerning maternity insurance, maternity riders, maternity discount plans, and other types of maternity coverage.
First of all, if you are a Florida resident and you are pregnant and do not have maternity coverage then you will not be eligible for maternity coverage under an individual health insurance plan. Those with the foresight to plan ahead and purchase some type of maternity coverage before they become pregnant are rewarded while those who wait until they are actually pregnant are of course not afforded individual maternity coverage. (If you are pregnant and have access to a group plan through you or your spouses’ employer then now is the time to seriously inquire about your enrollment options as many group health insurance plans usually cover maternity just as they do any other illness). Naturally, sick people always want health insurance and people with a pregnancy in the family always want some form of maternity insurance.
If you are not pregnant and would like to add on additional maternity coverage to your individual health insurance plan then there are a few things that you should know. Most individual health insurance policies will allow you some measure of maternity coverage in the form of a rider for an additional cost. It is quite common for a maternity rider to have a waiting period of at least 12 months before they pay out any type of maternity benefit. Still some other maternity riders, such as the one that Golden Rule/United Healthcare offers in Florida allow full benefits to be paid up to a set amount after 12 months and 50% of the benefit paid out beginning immediately.
So how much does a pregnancy in our example state of Florida really cost anyway? How much of a maternity benefit should I be certain to have? How much can I anticipate paying out of pocket for the pregnancy and related expenses? These are all important questions and the answer may be, “Not quite as much as you at first think.” According to FloridaCompare.gov the statewide average charge for a normal delivery is $1,689 while the statewide average charge for a cesarean section is $14,458. As you can see there is quite a range in the cost depending on if there are any complications present during the pregnancy.
The important thing is to know the options that are available to you and to obtain maternity insurance and health insurance before you need it!
The Myth Behind Maternity Insurance
Maternity is a period between conception and birth of the child. For most women and their partners alike, this period is filled with anticipation and excitement as they await the coming of their new baby. But this period can be quite burdensome too to the couple, especially to the mother. Aside from physical and emotional burden they experience, and lifestyle changes they have to deal with, the couple is faced with financial burden as well. Vitamins, maternity clothes, check ups and the baby’s stuff are only few of the things they must spend for. To aid expectant mothers get through this very important stage in her life, insurance companies provide assistance through maternity insurance plans.
A maternity insurance provides financial security to women who are in the pregnancy period. This is especially helpful to middle-income mothers who may not be able to pay for high costs of pregnancy and childbirth all at once. It helps them cut maternity costs and allows them to avail of appropriate health care, services and medication they and their child need. There may be some medical assistance programs that also help cut expenses during pregnancy but they are not enough while a maternity insurance covers more maternity expenses.
In the event of any complication that may cause the mother or the baby to stay in the hospital for a longer time and may require an operation or other medical services, the couple can count on the maternity insurance. For instance, if the baby is premature, he or she would have to spend weeks or even months in an incubator. Expenses incurred during the period of incubation may not be covered by existing medical plan but unexpected expenses brought by these eventualities may be covered by maternity insurance plans.
Getting a maternity insurance is one of the best ways one can take care of her baby even when he or she is not yet born. Financial security allows the mother to get the best prenatal care that shall ensure that the baby develops normally. Furthermore, with the help of a dependable maternity insurance company, the couple can eliminate worries on how to pay for pregnancy and childbirth expenses. Going through the maternity period without these worries but instead, with the right attitude and disposition, ensures that the mother can give birth to a child that is physically, mentally and emotionally healthy.
With all the risks involved in pregnancy and childbirth, getting a maternity insurance is a life-saving decision. It helps an expectant mother get through her life’s most crucial moment with security and hope. Moreover, maternity insurance is payable in easy installments so she and her husband can surely have more peace of mind. However, it is important to be extra careful in purchasing maternity insurance plan. If you are planning to get maternity insurance, make sure to get it only from a reliable insurance provider to prevent problems in the long run. It would be best to shop around first to know where to get the best maternity insurance policy that shall benefit you and your baby.
Maternity Insurance - 11 Benefits Covered By Maternity Insurance
A survey revealed that around 13% of pregnant women went without medical care during those difficult months as they could not afford maternity insurance. Also, pregnancy did not form a part of many health insurance policies. Sometimes, care was available only during the second trimester or third trimester. Affordable Health Care Options therefore offers hope in the form of the “Maternity Card”. This card allows slashing of costs during the prenatal and postnatal periods by up to 60%.
The name precisely means that - Affordable Health Care Options! Where Maternity Card scores over other basic health insurance programs is reduction in the amount of documents to be filled in, unlike its competitors who present the patient with a mountain of paperwork and legal jargon that is terribly confusing! And as mentioned earlier, this insurance is affordable. In truth, maternity insurance is not considered so important by plenty of health insurance programs.
Where those companies that do offer maternity insurance coverage are concerned, they provide group insurance plans. The catch is that in many of the plans, the clauses are so framed that they can take effect only three months later; sometimes, even one year later.
A plan called Medi-cal maternity insurance is meant for residents of California only. The woman should be between six to seven months pregnant, as well as prove that California has been her home for the past six months. The company takes care of prenatal expenses, as well as covers the postpartum period for 60 days. The remaining costs are covered by the woman herself (gross family income contributes 2%).
Low-income groups can turn to Medicaid for help, where a few maternity insurance benefits are available sometimes.
So I again reiterate that Maternity Card is the best option available. Pregnant women with no insurance can go for it. Even women with health insurance that does not include maternity insurance, can opt for Maternity Card. More details can be found from internet. All one has to do is fill out the information page on the site and click on submit. One will have access to lots of information about where to find good insurance.
The full maternity package provided by Maternity Card includes these services:
1. Visits to the doctor.
2. Prenatal vitamins.
3. 24-hour counseling.
4. Sonograms.
5. Laboratory work.
6. Stay in the hospital.
7. Anesthesiologist.
8. 24-Hour Nurse Hotline.
9. Checkups and tests concerning the newborn.
10. Immunizations for mother and child.
11. Prescription drugs.
Thus, the Maternity Card is so customer-friendly that the mother-to-be can stop having nightmares about the lack of maternity insurance or how she is going to manage monetarily when the baby finally arrives. There is somebody to take care of everything!
Maternity Health Insurance Coverage
A woman naturally gets excited when she finds out that she is pregnant. In many cases, this happiness is soon diminished when the financial burden of having a child is realized. Thirteen percent of American women who become pregnant have no maternity insurance coverage. They face the risk of inadequate pre-natal care and must find their own resources for funding the cost. If the pregnancy is complicated, this adds to the burden.
Even those with insurance may find to their dismay that maternity is not covered. A costly add-on premium may be required. Some insurers do not offer maternity coverage or consider it a pre-existing health condition. This is illegal by Federal law, and there are several loopholes.
There are many group insurance plans that do provide maternity coverage as a service to members. There may be a waiting period of three months to one year before the clause becomes effective. What happens if one becomes pregnant during the waiting period? If you are carrying COBRA (extended coverage from a previous employer), check to see if maternity is covered. This may be costly but well worth it.
Some states have plans for pregnant women like Medi-cal in California. Federally sponsored programs like Medicaid also exist, but they are mostly for low-income groups.
Another option is MaternityCard. It is designed to provide help to pregnant women and is well accepted. This covers a wide spectrum of maternity medical needs and less expensive than regular insurance.
Ideally, maternity coverage begins immediately. There are some women that naturally get excited when they finds out that they are pregnant. In many cases, this happiness is soon diminished when the financial burden of having a child is realized. Thirteen percent of American women who become pregnant have no maternity insurance coverage. They face the risk of inadequate pre-natal care and must find their own resources for funding the cost. If the pregnancy is complicated, this adds to the burden. There are some plans
that have a 30-day waiting period. Always study the package that is offered before accepting it.
How to Get Low Cost Maternity Health Insurance
Fifteen percent of American women do not have maternity health insurance and face overwhelming medical bills, especially if there are medical complications. Here’s how to get low cost maternity health insurance that could save you from financial disaster.
What is maternity health insurance?
Maternity health insurance is a health insurance plan that includes maternity coverage. As of this writing there are no stand-alone maternity health insurance plans.
You can purchase one of the following types of plans to get maternity coverage:
* An indemnity plan which lets you choose your own doctor and hospital, but is the most expensive type of plan.
* A managed health care plan (HMO, PPO, POS) that assigns you to a network of doctors and hospitals that you use for your medical care. These are the cheapest types of plans.
What does maternity health insurance cover?
Standard maternity health insurance policies cover your doctors expenses, your hospital fees, and your prescriptions drugs - basically all your maternity medical expenses.
Can I get maternity health insurance if I’m already pregnant?
Private insurance companies will not insure you if you’re already pregnant, but some states offer Medicaid health insurance, or plans such as California’s Medi-Cal, to low income families. To see if your your state has a low income maternity health insurance program, visit your state’s department of insurance website.
If you’re pregnant and don’t qualify for state sponsored maternity health insurance, the best thing you can do is call the hospitals in your area and see if you can negotiate a cheaper than normal rate. Most hospitals will give you a discount if you pay cash.
Where can I get cheap maternity health insurance?
The best way to get cheap maternity health insurance is to go to an insurance comparison website where you can get rate quotes from multiple insurance companies.
Working Family Values
When we send our children out into the world of work, we assume that if they can get their foot in the door and get a job, then they can move up the ladder and take care of themselves and their families. The job may not be perfect, but they will be able to make ends meet and have time to be both good workers and good parents.
The reality, however, is that millions of jobs in the United States are not these kinds of jobs. Nationwide, about one-third of jobs are low wage, paying less than two-thirds of the male median wage, and, more often than not, don’t come with health insurance, paid time off, or retirement plans. Many workers in low-wage jobs do not even know what their work schedule is for next week, let alone what they’ll do if they need a sick day.
Low-wage workers and their families are often excluded from what most of us would consider normal activities, such as taking a paid sick day if their child is sick. This is a moral outrage. In a nation where the majority of children do not have a stay-at-home parent, how should families cope when a child gets the flu? Leave the child at daycare and get all the other children sick? Risk their jobs by missing a day of work? Every day in the world’s richest nation, parents are forced to choose between being a good parent and being at their job.
One of the key characteristics of low-wage jobs is that they aren’t subject to the same kinds of basic labor standards as other jobs. High-wage jobs often provide the kinds of benefits that workers with families need, such as the flexibility to take an hour to take the children to the dentist and then make it up later, or paid time off for maternity and paternity leave. But those in low-wage jobs, who are also in need of family-friendly policies, simply don’t get these kinds of perks.
PUBLIC BENEFITS, such as Medicaid and child care subsidies, are supposed to fill the gap for workers who do not get on-the-job benefits. Yet we find that in states across the country, not only do benefits phase out long before you’re likely to get employer-based benefits, but few (often less than half) of those eligible actually receive benefits.
Most work support programs, including child care subsidies and Medicaid, focus on the poorest among us or those without employment. This leaves millions of working families-who are not what the government would define as poor, but who don’t earn enough to meet their basic needs and don’t get on-the-job benefits-struggling to make ends meet.
We need to think long and hard about what kind of economy we want to create for the next generation of workers. What are the basic standards that should be common to all jobs, not just the best jobs? At the very least, the United States should follow the lead of other advanced economies and provide paid time off for workers who are ill, have an ill family member, or need time to care for a new child. We should also ensure that safe, affordable, and enriching child care is available to every parent. We need to incorporate into our policymaking the recognition that those working in low-wage jobs may be unable to make ends meet and that their employers are not filling in the gaps with benefits.
It’s not just the very poor who need our attention. As members of the middle class have been squeezed, more and more of us are struggling to maintain our standard of living. The past 30 years have brought rising wage and income inequality and an increase in the low-wage, no-benefit jobs. If we want to see an economy that works for everyone, then we-and our representatives in Washington-must work for labor standards that support all workers.
Calif. paid leave law gets mixed reviews
When the nation’s first paid family leave law took effect in California in July 2004, opponents predicted doom and gloom for employers while supporters touted the new law as a wonderful economic boost that would free working parents to take time to bond with their babies or care for sick kids. Now, almost 10 months after paid leave has been available to workers in California, reviews of the program are decidedly mixed.
On one hand, many workers who were eager to use the new benefits are confused about how the program works. And many employers are frustrated by the lack of information and communication initially offered by California’s Employment Development Department (EDD), the agency charged with administering the program.
he program got off on the wrong foot last summer when a logjam of paperwork at the EDD delayed payments of nearly 7,000 initial claims for almost six weeks. Many workers who applied for the leave found themselves in dire economic straits, and officials with the EDD had to take emergency measures to ensure that many employees who desperately needed the money got their benefit checks.
The money to fund the program is deducted directly from workers’ paychecks, much like Social Security or Medicare deductions. Workers can collect 55 percent of their regular pay–up to $840 per week for six weeks–to care for a sick child, spouse or parent or to bond with a child less than one year old.
“Even though we direct our employees to the EDD web site for information and forms, they still come to us for guidance about what to expect, and especially how [paid family leave] is going to coordinate with the various other leaves that are available to them,” said Jennifer Troia, vice president of human resources for Sunesis Pharmaceuticals Inc. in San Francisco. “And since they are our employees, of course we want to help them out as best we can.”
The increased workload, Troia says, is a bit frustrating because the paid-leave program is supposed to be administered solely by the EDD. Employers are supposed to have minimal involvement, yet it has become a burden for Troia and her small HR department at Sunesis–a startup biotech company with 115 employees and plans to more than double its staff over the next two years.
The number of workers who have applied for the paid family leave has been much lower than originally projected. Between July 1 and the end of December, nearly 70,000 California workers filed for benefits.
At the end of 2004, the state had paid slightly less than $140 million in claims for the first six months–far less than the EDD’s original estimated payout of $190 million by that time or $380 million per year.
The number of claims had increased slightly through the first three months of this year but had yet to reach the state’s original projections. It’s unclear whether confusion over how the leave is administered or the limits on benefits payments has kept the number of claims lower than expected.
It is clear, however, to Troia that the limit on benefits is a disappointment to workers. “I just explained the benefits to an employee who had high hopes of taking time off to bond with his baby, and his response was: ‘That’s it? That really is no benefit to me then,’” Troia said.
Morale Is Undermined
The initial optimism over the new program for many workers has definitely soured and has undermined morale, according to some employers. Troia polled 50 of her colleagues informally at businesses located in the San Francisco Bay area and found that their employees have made similar complaints.
“When you consider the higher salaries of many high-tech employees and the expense of living in this area, the benefit really doesn’t do these workers much good,” said Mary Topliff, an employment attorney and management consultant in San Francisco.
However, other groups that supported passage of the leave law claim that it offers workers some financial security and allows them to take leave provided under both the California Family Rights Act (CFRA) and the federal Family and Medical Leave Act. California’s paid family leave law does not guarantee leave time; it offers only to compensate workers for taking family leave.
Topliff says that some employers have taken the situation in stride but that small employers have some legitimate gripes about the program.
“Many of my clients have asked me to help interpret the rules and regulations, which are pretty complex,” said Topliff.
The problem many employers face is coordinating the program with myriad federal and state leave laws, Topliff said. For example, the new paid leave law provides that employers can require an employee who applies for the leave benefits to take up to two weeks of accrued vacation and sick leave prior to taking paid family leave. However, according to the CFRA, businesses can’t require that employees take paid leave.
“So we’re faced with contradictory rules, and we have had to go to our outside counsel–at great expense, by the way–to find out which law applies. And this doesn’t even take into account how the federal Family and Medical Leave Act comes into play,” Troia said. “For smaller startup companies like ours, it has been particularly burdensome to spend the amount of time it takes to educate ourselves and our employees who want to take the leave.”
roia and Topliff agreed that the initial problems with the program have eased somewhat over the past year. However, they say they hope that California’s experience isn’t a glimpse into the future for other states or even federal law.
“I really can’t see this working well for other states, especially if they don’t have a state disability insurance program in place like California did,” Topliff said. “To start a program like this from scratch would be a real mess.”
California has had a statewide short-term disability insurance program for nearly 30 years. The program pays benefits to employees who have to take off time from work for illnesses or injuries. The state has a maternity leave program that is separate from the new paid family leave.
Safety, insurance, and the law: part Two in our insurance series seeks toclarify the grey areas around independent operators and WCB liability
Under the Workers Safety and Insurance Act, workers are entitled to disability benefits if they are injured on the job. In exchange for the right to obtain such benefits, the worker is prohibited from suing the employer for negligence. In Ontario, this arrangement is administered by the Workers Safety and Insurance Board (WSIB). However, whether an individual is covered by the Act and therefore eligible for benefits depends mostly on whether the person is an “independent operator” or a “worker.”
Similar issues also arise around employment standards legislation. Eligibility for overtime premiums, maternity leave, notice/severance pay, vacation pay and other provisions of the Act depend on the individual’s status as an employee under such legislation. Nor is it as simple as stipulating employment status in the work contract. Jurisprudence indicates that neither the courts nor employment-related statutory tribunals will allow the terms of the contract, by themselves, to determine whether an individual is an employee or independent contractor.
Courts and statutory tribunals will look beyond the wording of a contract, and are quite prepared to find that an individual is in fact an employee even when the parties have agreed among themselves that the relationship is one of engager and independent contractor. Previous cases have determined that where an individual is told not only what is to be done, but the way in which it shall be done, the means to be employed in doing it, and the time and the place where it shall be performed, then the individual is usually considered to be an employee. Where the individual performing the function in question has greater control over the how, the what, the when and the where the work is to be done, there exists much greater likelihood that the individual will be found to be an independent operator.
The employer is required to deduct income for tax remittance at source before paying an employee. No similar deduction is required when dealing with an independent contractor. In the event the independent contractor is later deemed to be an employee, the employer can be liable for the tax that should have been deducted at source. Under both pieces of legislation for the Canada Pension Plan (CPP) and Employment Insurance (EI), the employer may be liable for payment of both the employee’s and the employer’s contribution for a retroactive period, which includes all of the current year and up to three previous years, including interest and penalty. Also, the directors of a corporation assume personal liability for both of these payments under the respective Acts.
With regard to termination, unless the amount of notice to be given on termination is specifically set out in the contract, common law implies a reasonable notice provision on every contract of employment. Although employment standards legislation sets the minimum amount of notice and/or severance that must be given to an employee, the implied “reasonable notice” required by common law is many instances significantly more than the minimums required by the Employment Standards Act.
Potential liability can also be examined through the 1989 Regina v. Wyssen decision. A respondent was charged under the Occupational Health and Safety Act for failing to ensure that safety measures and legal procedures were carried out. He was handed a fine of $25 000 or imprisonment of not more than 12 months, or both. The respondent was a window cleaner who contracted out a portion of his work, which was beyond his capabilities, to an independent contractor who was an experienced window cleaner. The subcontractor supplied his own materials and had done work for the principal in the past. The independent contractor fell to his death when his rope broke. It was the opinion of the legislature that the “employer” be responsible for safety in the workplace and compliance with the Act.
Worker or Independent?
For Ontario WSIB purposes, a subcontractor may be a worker or an independent operator. According to WSIB, workers are automatically covered in the logging industry and the principal is required by law to pay premiums for this coverage. However, WSIB coverage for independent operators is not mandatory.
An independent operator in the logging industry operates a separate business from that of the employer and usually has the following characteristics: he/she is able to sell logs to others for the best price possible; reports to other government agencies as a self-employed business (CCRA, GST); owns and operates his or her own equipment as well. The first test alone excludes many current “independent operators.”
If a subcontractor does not have any employees, an organizational test is needed to determine whether a subcontractor is a worker or an independent operator. The test examines the work relationship between the individual and the principal. The Board outlines such factors as degree of control and opportunity for profit or loss to characterize the working relationship. It is an extension of the control test and is used to determine whether a separate business entity exists.
Insurance options, decisions abound
That phrase reminiscent of “The Wizard of Oz” conveys the frustration faced by consumers when trying to pick a health plan. At the same time, companies spend hours and hours developing marketing campaigns to help clear up confounding insurance lingo, and woo consumers to their company.
During the most recent open-enrollment period, held September to November 2002, three health-insurance companies - Excellus BlueCross BlueShield, Central New York Region (BCBSCNY); HealthNow New York, Inc.; and MVP Health Care - advertised anywhere and everywhere to try to accomplish this mission. None of the companies would disclose exact marketing figures due to the competitive nature of the business.
MVP took an innovative approach,
developing an advertising campaign formally titled “People for Better Care” that directed potential customers to a Web site, www.joirunvp.com. The campaign was launched Sept. 29 and ran until late November. MVP members, employees, and business owners served as spokespeople for the company in the ads, which ran on television, radio, billboards, and in print.
The campaign appears to have been successful, as nearly 36,000 people visited the site during the open-enrollment period. This is about twice as many as during the same period in 2001.
As a result of the campaign, the company boasts nearly 14,400 more members (67 percent) than last year in its Mid-State Region, which covers Cayuga, Cortland, Onondaga, and Oswego counties. The company’s Central Region has 56,734 members and added 6,747 (14 percent) since last year, while the Southern Tier Region has 32,000 members in Broome, Chenango, Tioga, and Chemung counties.
In August 2002, MVP decided to switch its approach to open enrollment to promote its new products.
“We had a little bit of a challenge because, when we were strictly an HMO, we were able to advertise … specific benefits to being a member of our HMO [with an] emphasis in preventative care,” says Gary Hughes, MVP’s associate director of public relations. “We found we needed to spend less time in ads specific benefits and more on developing the MVP name and [plan] flexibility.
” is a way to provide people with a more in-depth look at the health plan than we could do with the, other ads,” Hughes adds. “We had a very good fall enrollment season in terms of growth in Central New York and the Syracuse area.”
Overall, MVP has approximately 550,000 members in eastern New York State, Vermont, and small portions of western Massachusetts and northern Pennsylvania. The company was founded in 1983 as the Mohawk Valley Physicians Health Plan and shortened its name to MVP a few years ago.
According to Hughes, MVP developed its campaign because of market research
- and not based on other companies’ advertising.
” do not have near the impact as does research with existing customers and market research with prospective customers,” Hughes says. “We’re proactive in advertising, not reactive.”
And when we are, we focus on what market research tells us and not what competitors are doing.”
Hughes says MVP’s rates are about 10 percent higher than last year, but conveys that the increase was less than from 2001 to 2002.
“We provide the advantages of a large company and the intimate attention that people are used to seeing from a smaller company,” Hughes says. “I think that’s what we were trying to in those ads.”
Traditional approach
BCBSCNY designs plans with employcis in order to control costs and provide a high level of benefits.
“Our most successful marketing efforts continue to be those that demonstrate our ability to respond to the changing needs of our customers through our broad portfolio of new and existing products,” says Elizabeth Martin, vice president of communications for BCBSCNY.
SCNY uses its Web site an integral part of member recruitment.
“Prospective members can read more about our health plans, find out if their doctor participates through our searchable provider directory, and complete a new membership application online,” Martin says. “Our Web site is just one of several tools that we use to enhance our overall customer service.”
BCBSCNY recently created “My Health Plan Advisor,” an interactive tool that allows individuals to peruse the company’s many plans and compare two or more plans simultaneously.
In 2002, the company experienced a 3.5-percent growth and now boasts 700,000 members in the region - which includes Cayuga, Cortland, Jefferson, Lewis, Oswego, Onondaga, St. Lawrence, and Tompkins counties.
“We feel we had a successful open-enrollment period that met our goals for membership acquisition and retention,” Martin says.
According to Martin, BCBSCNY raised premiums for some groups “in response to increased demand and utilization of medical services, the increased costs associated with new procedures and new technologies, and the rising costs of prescription drugs.”
While Martin did not release an exact rate increase, she referred to a study that showed that BCBSCNY has a 7.1-percent administrative cost, which is 40 percent less than the average national rate. The information was based on a study conducted by Milliman USA, Inc., entitled “Healthcare Administrative Cost Trends.”
Syracuse’s newest entree HealthNow is the newest health-insurance company in the Syracuse area. According to Syracuse General Manager Wendy Kotcamp, HealthNow expanded to the Salt City last year and boasts 6,500 local members, and 20,000 members in 27 counties across New York State. That number represents the company’s infancy in the area, Kotcamp says.
“HealthNow is not a new company in New York State, but a new name in Central New York,” she says.
Therefore, HealthNow tailored its marketing campaign toward introducing local residents to the company. The theme of the ads focused on the company’s readiness when health problems may arise for its customers.
“We want people to be more familiar with the name before they select us for their health plan,” Kotcamp says. “The objective is to increase brand awareness in the market.”
The organization sponsored more than 42 events around the community last year as a corollary to that approach, Kotcamp says. This includes sponsorships of events that benefit Syracuse Stage and the Susan G. Komen Breast Cancer Foundation.
Meanwhile, the company served as the primary sponsor for the Ride for Research with the American Lung Association - a four-day, more than 300-mile bicycle event from Saranac Lake to Ithaca that benefits tuberculosis and flu research.
The company’s advertisements which ran on television, radio, print, billboard, and through direct mail - directed consumers to call a toll-free number or visit the company’s . And like other companies, ads are created independently of what competitors may offer.
“We look at what message we’d like to deliver and our strategy in each market. Our plan is developed based on those things,” Kotcamp says. “What another insurance company decides to be [important] in [this] market doesn’t affect what we do.”
HealthNow takes a unique approach to setting premiums, adjusting rates every quarter but sticking to annual rates. This allows consumers to sign up throughout the year and helps HealthNow analyze cost and utilization trends, Kotcamp says.
Finally, HealthNow announced a partnership with MetLife in November to recruit new members. This arrangement, through MetLife’s Small Business Center, allows small businesses to purchase a package that features life and health insurance. The package is available to businesses with two to 50 employees in the Syracuse and Rochester areas.
“We sell their life insurance and they sell our health insurance,” Kotcamp says.
Who offers what and how?
Excellus BlueCross BlueShield, Central New York Region; HealthNow New York, Inc.; and MVP Health Care offer many health plans to their customers. A sampling of that list is below.
From here to maternity - maternity care and portable benefits - Column
A pregnant woman who changes jobs no longer has to worry about continuing coverage for the care she and her baby need, thanks to the new federal health insurance legislation. Eliminating potential gaps is a wise move, because good prenatal care is the best way to prevent low birth weight and prematurity and could improve the United States’ dismal ranking of 24th in infant mortality among developed nations. Nearly 16 percent, or more than 7 million, working women had no health insurance in 1993, the most recent year for which statistics are known. Even women with coverage don’t always get early and regular prenatal care.
Increasing the use of prenatal care would not only improve the overall status of the country’s health but also reduce what is frequently the single largest component of employers’ health costs. The care for one complicated birth and one sickly newborn can run anywhere from $20,000 to more than $1 million, compared to about $6,400 for a normal delivery and healthy baby. Bear in mind, too, that women now comprise nearly half the nation’s workforce.
That’s why Miriam Jacobson of the Washington Business Group on Health (WBGH), says, “Healthy mothers and healthy babies mean a healthy bottom line.” WBGH recently tracked large companies’ attempts to improve outcomes and lower childbirth costs. On-site obstetricians, preconception appraisals and beepers for expectant fathers, Jacobson says, were among the most innovative practices.
“On-site prenatal programs don’t just save money, but are good for morale, productivity and employee commitment to a company,” says Ellen Cutler, director of worksite programs at the March of Dimes, which has helped more than 5,000 firms establish them.
First Chicago NBD began its onsite program, Babies and You, in 1987 to ensure that women, who comprise nearly two-thirds of the company’s 35,000 workers, get good prenatal care. The average cost of birth is now at $8,250 for program participants and $10,000 for nonparticipants. Women who complete the program have fewer C-sections and low birthweight babies.
Among the services provided are confidential preconception risk appraisals and prenatal classes, where pregnant women receive tips like taking a daily dose of folic acid to prevent fetal development of spina bifida. Ranked No. 2 on Working Women’s list of healthy companies, First Chicago rewards those who complete the program by the 16th week of pregnancy with a $300 credit toward their health plan’s deductible.
Removing the financial barrier to care helped Dallas-based Haggar Clothing lower childbirth costs as well. The manufacturer began paying for 100 percent of pregnancy-related care–everything from doctor visits and delivery fees to prenatal vitamins–in 1998, after discovering its low-wage workers often skimped on prenatal visits because they couldn’t afford the $500 co-pay. Top claims for Haggar’s 4,500 mostly female workers consistently included premature, low birthweight babies and complicated pregnancies.
To receive full coverage, Haggar employees must keep all regularly scheduled doctors’ appointments and get precertified with a utilization review company in the first trimester. In 1994, the cost per birth fell to $5,574, down from $6,119 in 1991.
An innovative partnership with the Weld County Health Department is making prenatal care more accessible for workers at Monfort, a meat packing firm headquartered in Greeley, Colo. The company had fully covered preventive services for its mostly Hispanic workforce since 1984, but a 1990 study revealed that many of the women weren’t getting prenatal care because of a lack of Spanish-speaking providers. The result? Treatment of premature babies amounted to fully 10 percent, or some $3 million, of Monfort’s medical costs. At the county health department, bilingual staff are on hand to provide family planning services, prenatal checkups, screening tests and well-baby care –all accessible to employees with no forms, co-pays or deductibles.
Expectant fathers are the target of a work/family program at Los Angeles Department of Water and Power (LADWP), where three out of four of the 9,500 employees are male. Men whose partners are pregnant attend classes where they’re encouraged to abstain from smoking, especially at home, support the expectant mothers’ need for healthy food and assume more household tasks. Fathers-to-be also are given beepers in the last month of pregnancy. For every $1 spent on its work/family programs, LADWP says it realizes at least $2.50 in savings.