Surrogacy Insurance: Understanding US Health Insurance

Health insurance in the United States, unlike in many European countries, is largely administered by private companies. Exceptions include Medicare, a government-run insurance program for those aged 65 and older; and Medicaid, which provides health insurance for those with lower income levels.

surrogacy-insuranceBecause of the variability in plans and payment structures, U.S. health insurance can cause confusion for those who aren’t familiar with how it works. If you’re feeling overwhelmed by the American system, don’t worry! We’re breaking it down here to make it easier to understand.

We’ll talk elsewhere about insurance plans available through Lloyd’s of London, that are specifically designed to cover surrogacy costs. For now, we’re focusing on standard health insurance plans—plans that, in some cases, may cover the cost of maternity and/or newborn expenses.

Getting coverage

Many Americans obtain insurance coverage through a place of work. Employers often pay for at least a portion of the costs of the health insurance as a benefit offered to their employees. Most often, these insurance plans are administered by private insurance companies. Some of the largest insurance providers in the United States include: Unitedhealth, Aetna, Cigna, Humana, and Blue Cross Blue Shield. But companies can have their own self-funded plans and use an insurance company as a claims administrator, to handle paperwork.

Those who do not have insurance through an employer can often purchase individual insurance plans directly from insurance companies.

Understanding the terms

When you are dealing with U.S. health insurance, you may encounter a number of terms you haven’t heard before. Here we outline and clarify some of the most common ones:

1.  Explanation of Coverage/Benefits Booklet/Outline of Coverage, etc.: This is a document that provides all of the details of an insurance plan/policy.

2.  Premium: A premium is an amount paid each month or each pay period in exchange for insurance coverage. If the plan is through an employer, the employer may pay the entire premium or a portion of it. Typically the premium amount does not change from month to month; however, it might increase once a year.

3.  Deductible: A deductible is a dollar amount in covered medical expenses that must be paid by the insured person before an insurance company will provide coverage for certain services. The amounts paid as premiums generally do not count towards the deductible. Some plans have no deductible so there is no minimum amount of expenses required before insurance coverage begins. Once the deductible has been paid, we often say the deductible has been “met” and the insurance coverage begins. There are often two types of deductibles: individual and family.

Individual Deductible: Once a member reaches his/her individual deductible, the insurance covers a percentage of expenses for any remaining covered procedures or treatments for that member, for the rest of the year.

Family Deductible: A family deductible is typically a higher amount (often at least twice the individual deductible). Once the family reaches this designated amount, the insurance covers expenses (at a designated level) for any covered procedures for any family member for the rest of the year. It might require 2 or more family members to reach their individual deductibles, in order for a family to reach its family deductible.

surrogacy-hospital 4.  Copayment: A copayment is an amount that might be required for some services—most often, office visits to a doctor or hospital stays. Unlike coinsurance, it is not a percentage of expenses, but instead a set amount. Copayments may or may not count as a contribution towards the deductible or out-of-pocket limit (see below).

Example: An insurance plan might establish a $25 copayment for office visits to a member’s doctor, a $35 copayment for office visits to a specialist, and a $500 copayment for each admission to the hospital.

5.  Coinsurance: Once a deductible is met, insurance companies typically pay for the majority of expenses for covered services. But insured members may still be required to pay for a percentage of these medical expenses. Often, insurance companies will cover 70% or more of expenses. Circle does not approve insurance policies with lower than 70% coverage. The remaining percentage, paid by the insured person, is referred to as the coinsurance. Some plans require no coinsurance, and instead pay for 100% of covered services after the deductible.

Example: Let’s continue the example above. If a member undergoes a covered procedure at the beginning of the year that costs $11,000, he/she would be required to pay $1,000 (the deductible) before the insurance company pays anything. The remaining expenses are $10,000. If the coinsurance is 20%, the member would pay an additional $2,000 and the insurance would cover the remaining $8,000. Because the deductible has been met, the member doesn’t have to pay it again for the remainder of the year term. (Keep in mind, some insurance plans follow the calendar year and begin on Jan. 1, while others may begin at a different designated date.)

6.  In-Network/Out-of-Network: Insurance companies are often able to obtain better rates with some medical providers. For this reason, the level of insurance coverage for certain hospitals or doctors may be higher than for others. Those providers or hospitals with the higher levels of coverage are considered in-network while those with lower levels of coverage (if any) are considered out-of-network. An HMO (see below) may not offer the option of working with out-of-network providers.

Example: Continuing our example from above, let’s assume the insurance plan provides 80% coverage for in-network providers and 70% coverage for out-of-network providers. The member would owe $2,000 after the deductible for an $11,000 service if the provider is in-network, but $3,000 after the deductible for a $11,000 service if the provider is out-of-network.

7.  Out-of-Pocket Limit/Maximum: Once a deductible has been met, an individual may begin paying coinsurance on covered services. But insurance companies often establish a maximum amount that a member has to pay. That amount is called the Out-of-Pocket limit or Out-of-Pocket maximum. This amount should include any coinsurance paid, and may or may not include the deductible or copayments. There may be higher out-of-pocket maximums for Out-of-Network providers.

8.  Dependent: An insurance plan has a primary member, but he/she can typically choose to add coverage for certain additional people, such as a spouse and children. Anyone who is not the primary member of a health plan is considered a dependent. Dependents may be required to meet certain eligibility criteria in order to be added to a plan. Newborns may or may not be automatically added to a member’s plan.

Example: Again, let’s continue the example above. An individual pays monthly premiums, and incurs a medical expense of $11,000 at an in-network provider. He pays the $1,000 deductible, and 20% of the remaining $10,000 (that is, $2,000). Now, assume he has an individual out-of-pocket maximum of $3,000 that includes the deductible and coinsurance. Since he has already reached this total (by paying a $1,000 deductible and $2,000 in coinsurance), any remaining covered medical services for the year should be paid by the insurance company at 100%.

9.  Qualifying event: This term typically refers to an event (such as a birth, marriage, or divorce) that the insurance company determines is sufficient in order for the primary member to add or remove dependents or change coverage. Outside of a qualifying event, members generally must wait until an annual enrollment period to make changes.

10.  Exclusions: If an insurance company decides to provide no coverage for certain services, those services or procedures are said to be exclusions. Exclusions must be outlined in a document provided to the insurance plan members. Insurance companies have an obligation to write insurance documents clearly – any ambiguity is construed in favor of the member in the event of a dispute.

11.  COBRA: The acronym COBRA comes from the Consolidated Omnibus Budget Reconciliation Act, a federal law. However, in insurance contexts, it refers to the act of continuing insurance coverage obtained through an employer when the member has left the job that originally provided the insurance. Members may have to pay higher premiums in order to “COBRA” their old insurance and can do so for up to 18 months in most cases.

12.  HMO: A Health Maintenance Organization (HMO) is a type of health insurance plan that limits its members to specific providers and hospitals. Typically, members cannot use out-of-network providers except in emergencies.

13.  PPO: A Preferred Provider Organization (PPO) is a type of health insurance plan that allows members to pay less for using certain providers. You pay more to use out-of-network providers.

14.  Limits: Plans may place a specific lifetime or annual dollar limit on benefits. However, these limits have been severely restricted by the Affordable Care Act (ACA).

15.  Affordable Care Act (ACA)/”Obamacare”: The ACA, is a U.S. law passed in 2010 that made significant changes to the U.S. healthcare system, including creating an “individual mandate” that requires that most Americans have health insurance in place, and health insurance exchanges, where people can compare insurance plans and purchase policies online.

16.  Open enrollment period:  This refers to the window each year during which people may join qualified health insurance plans. Currently the next proposed Open Enrollment Period for policies available on the ACA health insurance exchange is November 15, 2014–February 15, 2015.

Working with an experienced surrogacy agency with a legal team on staff ensures that you can receive guidance on surrogacy insurance issues and have all of your questions answered.

photo credit: shehan365 via photopin cc

Surrogate Screening Process: How is a surrogate approved?

surrogate screening process

While surrogates come from a wide range of backgrounds, they all have one thing in common: These women want to help a deserving family grow. To ensure that every surrogate we accept is physically, mentally and emotionally prepared to begin her surrogacy journey, Circle implements a very thorough application and screening process.

There are many steps that a surrogate goes through before she is accepted into our program. The guidelines we follow are in place for the benefit of the surrogate and the intended parents.

Here we take a look at what the screening process looks like.

  1. Prospective surrogates complete an online application, which consists of roughly 100 questions to gauge whether or not an applicant is a fit for Circle. The application reflects our strict requirements for initial approval, which include proof of (a) previous healthy birth(s), residence in a surrogacy-friendly state, no history of illegal drug use, and no history of alcohol abuse. Often, intended parents will have chosen a reproductive endocrinologist before a match is even made. This doctor will review a potential surrogate’s medical records to see if she is an acceptable medical candidate.
  2. If an applicant meets the necessary criteria in her initial online application and is medically cleared, she will next complete a thorough panel of assessments with a licensed social worker. Both she and the person she identifies as her primary support person (most often her partner) undergo criminal background checks, bankruptcy/judgment history checks, and psychosocial screenings.
  3. The final piece of the approval process is the in-person medical screening, which follows the guidelines of the American Society for Reproductive Medicine and takes place at the IVF clinic. Depending on the clinic, some doctors will choose to also evaluate the potential surrogate’s partner for medical clearance.

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Surrogacy Financing Options Now Available

Today, Circle is proud to announce new surrogacy financing options for U.S. intended parents. We’ve partnered with American Healthcare Lending (AHL), which offers simple interest installment loans in amounts up to $100,000.

surrogacy-financing The loans are available at rates as low as 5.99% in up to 84-month terms with no pre-payment penalties. Funds are deposited directly into the intended parents’ accounts and can be applied to any fertility treatment, procedure, medications, agency fees, and out-of-pocket expenses.

Circle Surrogacy believes that everyone has the right to pursue their dream of family and that financial burden should not be a roadblock to making that dream a reality. The new surrogacy financing option continues our tradition of developing innovative financial programs for intended parents, like our exclusive unlimited IVF packages and unlimited rematch program, which we unveiled earlier this year.

“We’re thrilled to offer this option, which gives our intended parents greater financial freedom and flexibility when planning their surrogacy and egg donation arrangements,” says Scott Buckley, Circle’s Director of Operations.

Intended parents can apply online for the surrogacy loans in less than a minute and receive an instant pre-approval without affecting their credit thanks to the trusted financing program. American Healthcare Lending offers a secure and confidential online process that allows intended parents to review their rate, payment, and term before accepting.

Highlights of the surrogacy financing program:

  • Loans available in up to 84-month terms, in amounts from $2,000 – $100,000
  • Two-tiered program with options for borrowers with standard and exceptional credit
  • Interest as low as 5.99%
  • 640 recommended minimum credit score
  • Instant online decisions for loans under $35,000
  • Receive funds via ACH deposit in a few days
  • No pre-payment penalties
  • No collateral required

For more information about the surrogacy financing program, contact Bruce Hale.

Pennsylvania Takes a Stand on Same-Sex Marriage

pennsylvania marriage equality
2014 is looking like the “it” year for marriage equality. Yesterday morning, Pennsylvania’s federal judge John E. Jones III struck down the state’s ban on same-sex marriage. Not only did the state’s ruling bring gay couples and LGBT advocates and allies a reason to celebrate locally; Pennsylvania was the last remaining state in the Northeast to ban same-sex marriage.

This news brings solace and pride to human rights advocates across the globe as the nation makes yet another step towards equality for all.

While the fight for marriage equality in the U.S. continues, Judge Jones leads the way in the powerful, final words of his ruling: “We are a better people than what these laws represent, and it is time to discard them into the ash heap of history.”



 

photo credit: Elvert Barnes via photopin cc

Arkansas Says “I Do” to Marriage Equality

Gay Marriage Arkansas Good news travels fast. In the wake of Friday’s ruling that overturned a gay marriage ban in Arkansas, dozens of same-sex couples lined up outside courthouses in Little Rock and Fayetteville to legalize their unions.

The Associate Press reports that Pulaski County Circuit Judge Chris Piazza said that the state’s 2004 voter-approved constitutional amendment that defined marriage as between a man and a woman violates the constitution. The ruling comes to a surprise to many who reside in the Bible Belt state, as the 2004 amendment was passed with the overwhelming support of Arkansas voters.

This makes Arkansas the most recent U.S. state where judges have struck down bans on gay marriage. Judges in Michigan, Oklahoma, Texas, Utah, and Virginia have struck down their state’s gay marriage ban. Further, judges in Tennessee, Kentucky, and Ohio have ruled that that they are to recognize same-sex marriages issued in other states.






Family Building: A Modern Day Mother’s Day

surrogate mothers dayGone are the days of TV Dinners, transistor radios, poodle skirts, drive-in movie theater dates, and soda fountains. Gone are the days of the “typical American family.” We live in a world in which normalcy is rapidly dissolving. The lines of tradition have been blurred by society’s social transformations, and we can now say, with pride, that families do not come pre-conditioned.

Mother’s Day is a holiday that has not quite caught up with the times, as many children are raised without a mother. And while the phrase “without a mother” denotes an absence, let us remind children born through surrogacy that they were brought into this world through an act of unconditional love.

They may grow up with two daddies; they may grow up with one. While they may not have a biological mother or they may have a mother who needed the help of a surrogate to have her own child, they have the everlasting gift of love and life from their journey entering the world given to them by a surrogate.

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Circle Attends OMG! Cancer Summit for Young Adults

OMG 2014The “OMG! Cancer Summit for Young Adults” is the only conference of its kind to address the needs of young adult cancer survivors under age 40. The seventh annual event brought together survivors, caregivers, and advocates to address common quality-of-life issues that affect this age group, such as body image, dating, employment, and cancer-related infertility. Over three days in Las Vegas, Nevada, the conference (presented by Stupid Cancer) highlighted speakers, had breakout sessions, and gave attendees the opportunity to network, professionally and socially.

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Surrogacy Terms: Gestational Carrier vs. Surrogate

Gestational carrier. Gestational surrogate. Surrogate. Surrogate mother.

These words are used, often interchangeably, to describe a woman who carries a child for intended parents. So why do these different surrogacy terms exist? And which one is the right one to use?

Let’s start by distinguishing the two types of surrogacy – traditional surrogacy and gestational surrogacy.

surrogacy-termsIn a traditional surrogacy, the woman who carries a pregnancy for intended parents also shares a genetic connection to the child or children she carries. Because only the intended father (or a sperm donor) contributes genetic material, the pregnancy can be achieved through artificial insemination (a procedure that allows sperm to be inserted directly into the fallopian tubes, cervix, or the uterus of the woman who will carry the child).

Until the development of in vitro fertilization (IVF) in 1978, traditional surrogacy was the only type of surrogacy possible. IVF is a technique that allows embryos to be created outside the womb. In the procedure, eggs from an intended mother or egg donor are retrieved through a surgical procedure. They are then fertilized with the sperm from an intended father or sperm donor.

The use of IVF led to the second type of surrogacy—gestational surrogacy. Since the 1990s, gestational surrogacy has grown to become the more popular type of surrogacy and it is now almost the only type of surrogacy arranged by surrogacy agencies. Some estimates suggest that 99 percent of today’s surrogacy arrangements involve a gestational surrogate.

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