Do self funded health insurance plans have to cover the 'essential' stuff?

Asked August 7, 2013, 2:43 PM EDT

My wife and I are thinking of having a child. I read somewhere that maternity care is 'essential' coverage under Obamacare. My employer has a self funded plan. Do self funded plans have to cover the 'essential' stuff?

St. Louis County Missouri personal finance health finance health insurance affordable care act health insurance literacy

2 Responses

Maternity care is an essential benefit, kind of like a minimum requirement, under individual and small group plan choices available both inside and outside of the Health Insurance Marketplace. Some rights and protections brought about by the Affordable Care Act apply only to plans made available in the Marketplace or other individually purchased insurance or small group plans. Maternity care is one kind of coverage that is not mandated under certain circumstances including grandfathered plans, those purchased prior to March 23, 2010, and employer self-funded (self-insured). Though self-insured plans are not required to cover maternity and newborn services, your employer may choose to provide this coverage. Self-insured companies collect premiums from employees and assume the responsibility for paying claims, sometimes contracting with outside service providers for things like wellness programs and billing services, etc. Check with your human resources office to be sure what your employer's coverage includes.

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