Why plans exclude surrogate pregnancies
The insurance review is a screening step in which Private Label Surrogacy sends your health insurance policy to an independent insurance specialist. The specialist reads the full plan document, not the summary, and looks for one thing above all: a surrogacy exclusion.
Plans exclude surrogate pregnancies for a simple reason. An insurer prices maternity coverage for members having their own children. A surrogate pregnancy is planned, compensated, and carried for someone outside the policy. Some insurers treat that as a cost they did not agree to cover. Some plans write a specific exclusion for it. Some exclude only compensated surrogacy and cover an unpaid one. Others say nothing about surrogacy at all, and that silence is a question the specialist has to answer.
The summary of benefits you get at open enrollment rarely mentions any of this. The exclusion, if there is one, sits in the full plan document. That is why the specialist reads the whole thing.
What you provide for the review
You provide:
- Your insurance card, front and back.
- The plan documents, sometimes called the certificate of coverage or the summary plan description. Your HR department or the insurer's member website can provide them.
- The name of the employer or marketplace the plan comes through.
If you cannot find the plan documents, tell your case manager. She will tell you exactly what to request and from whom.
The review takes about one to two weeks. It costs you nothing. The intended parents pay for it as part of screening.
What the specialist checks
The specialist reads the plan for:
- A surrogacy exclusion, stated outright or folded into the maternity section.
- Reimbursement or lien language, which lets the insurer recover costs from your compensation after the fact.
- How the plan is funded. A plan self-funded by a large employer follows different rules from a fully insured plan.
- Your deductible and out-of-pocket maximum, so the intended parents know what they will reimburse.
- Renewal dates, because a plan that covers you today may change at the next plan year.
You and the intended parents both learn the answer before you match. No one commits on a guess.
What happens if your plan covers surrogacy
If your plan covers a surrogate pregnancy, it stays your primary coverage. Your prenatal care and delivery are billed to your plan as they would be for any pregnancy.
The intended parents reimburse your premiums, your deductible and your copays for the pregnancy through escrow. You should not carry the cost of the pregnancy yourself. Submit each bill to your case manager and the escrow agent as it arrives.
What happens if it excludes surrogacy
If your plan excludes surrogacy, the intended parents buy a surrogacy-friendly policy for you. That policy costs them $5,000 to $40,000. It is usually in place before the medical cycle begins.
You do not pay for the policy and you do not lose your own coverage. Your existing plan keeps covering you and your family for everything that is not the surrogate pregnancy. Details of how the replacement policy works are on surrogate insurance.
| Plan type | Typical surrogacy coverage | Usual solution |
|---|---|---|
| Employer, fully insured | Varies; follows state insurance rules and the policy wording | Specialist reads the policy; parents reimburse costs or buy a policy |
| Employer, self-funded | Varies most; the employer writes its own rules, and state mandates generally do not apply | Specialist reads the plan document; a separate policy is common |
| ACA marketplace | Maternity care is an essential benefit, but some policies exclude surrogacy or seek reimbursement | Specialist reads the policy; timing depends on open enrollment |
| Medicaid | Not applicable | PLS requires that surrogates not receive government assistance |
| Tricare | Covers maternity care but may seek reimbursement from surrogate compensation | Specialist advises; parents usually buy a separate policy |
| No insurance | None | The intended parents buy a surrogacy-friendly policy |
The Tricare statement is under review by counsel and by the insurance specialist PLS uses. For why government assistance rules out candidates, see government assistance and surrogacy.
Open enrollment timing and ACA marketplace plans
Timing matters. Marketplace plans can usually be bought or changed only during open enrollment, or after a qualifying life event. Employer plans change at the start of each plan year.
If your plan renews or changes partway through your journey, your coverage can change with it. Tell your case manager before you change plans or jobs. The specialist can review the new plan before you switch, not after.
If the intended parents need to buy a policy, the purchase date may depend on enrollment windows too. That is one reason the insurance review happens early in screening rather than after you match.
What this means for your own family's coverage
Your family's coverage does not change because you become a surrogate. Keep your plan, keep paying your premiums, and keep your children and partner on it. If your plan is your primary coverage for the pregnancy, the intended parents reimburse the costs the pregnancy creates.
You should not misrepresent anything to your insurer. The review exists so that no one has to guess. It identifies whether your plan covers the pregnancy, and your agreement follows that answer. Your own attorney, paid by the intended parents, writes the insurance terms into your agreement. See the legal contract.
If you are ready to start, the first step is the prescreen: see if you qualify.
Sources
- Private Label Surrogacy screening process and third-party costs, pending confirmation by Nancy Block, RN.
- HealthCare.gov, essential health benefits and open enrollment.
- Tricare, maternity care coverage. Pending review by counsel.