HealthShares, designed primarily to help with unforeseen medical expenses, often accommodate maternity needs. Although most HealthShares offer maternity sharing, the extent can vary significantly. Certain HealthShares reserve maternity care for their top-tier plans, while others may limit sharing to OB-GYN appointments. Members and prospective members contemplating parenthood should be aware of several relevant factors.
Impact of maternity needs on member responsibility
HealthShares typically stipulate a distinct member responsibility amount for maternity needs, often in the form of a fee or a separate unshared amount. The implication of this is that maternity needs might incur higher costs compared to other needs. For example, Altrua HealthShare specifies a $5,000 maternity unshared amount; the CHM Gold plan has a set $500 member responsibility amount per pregnancy; and United Refuah HealthShare charges a “Pregnancy Fee” between $0–$2,500, depending on the number of members in the household.
HealthShares aim to reduce overall costs, thereby lessening the financial strain on the entire community. Consequently, HealthShares expect members to pursue cost-saving measures. If a substantial discount can be obtained through a prepayment plan, a HealthShare may share this expense even before the baby is born. However, some HealthShares will not share in maternity costs until all final bills are submitted.
Potential restrictions on maternity needs
Hurdles on the path to maternity need sharing are not unheard of. Membership must be established prior to conception, and if conception occurs before the completion of any initial waiting period (typically 60-90 days), the maternity need will not be shareable. Potential waiting periods should be factored into family planning.
Additional restrictions related to maternity eligibility are linked to the HealthShare’s member guidelines and statement of belief or standards. For example, some HealthShares may prohibit sharing in the maternity expenses for an unmarried woman.
While certain HealthShares might not explicitly state ineligibility for pregnancies of unwed mothers, non-compliance with member guidelines could lead to needs being ineligible for sharing. One example of this is Samaritan Ministries’ member guidelines: members agree to “abstain from any sexual activity outside of traditional Biblical marriage as designed by God between one man and one woman.” Such restrictions, given the industry’s predominant religious roots, should not be unexpected.
Yet, other HealthShares like Sedera and Zion HealthShare accommodate maternity for single memberships or unmarried members. In any case, proof of active membership at the time of conception might be required, such as a doctor’s note indicating an official due date. Sedera may consider sharing for a pregnancy conceived prior to membership, but in a limited capacity.
Planning a home birth
Alternative labor and delivery providers or locations, including home births, are included in the sharing of some HealthShares. Since these options are generally less expensive than a hospital delivery, some HealthShares may reduce the standard maternity responsibility amount. For example, both Sedera and Zion HealthShare may reduce your unshareable amount by half if the costs for a home birth or birthing center are significantly lower than a hospital delivery. If a member is planning for a home delivery, they should carefully review the member guidelines, or even contact their HealthShare directly to ensure their birth plan aligns with services eligible for sharing.
Caring for a newborn
If a pregnancy is eligible for sharing, a newborn can be readily included in the membership. Conversely, if a pregnancy is not eligible, there may be a 30-day waiting period after birth before the infant can be added. Shareable expenses for a newborn typically encompass services like an in-hospital pediatrician appointment and some immunizations. After a few initial services, a newborn is considered a separate member whose needs require an independent member responsibility amount.
Addressing infertility
With more couples finding conception challenging and opting to explore options like adoption, surrogacy, or fertility treatment, HealthShares can offer some solutions, albeit in limited capacity. While HealthShare communities do not share in fertility or surrogacy expenses, regardless of whether or not the surrogate is a member, they often share healthcare costs for adopted children as though they were the member’s biological children.
However, direct adoption expenses are not shared by all companies. Potential adoptive parents may consider Altrua HealthShare and Medi-Share, as these two companies extend sharing to adoption-related expenses, treating them as maternity needs.
A viable option
HealthShares offer effective ways to handle maternity expenses. Those considering parenthood should thoroughly examine the details of maternity sharing outlined in their HealthShare’s member guidelines.
