Are maternity expenses eligible for sharing?

Maternity expenses are eligible for sharing if the mother is a member and the Estimated Due Date (EDD), as documented in the medical record, is at least 10 months after the mother’s membership start date. The documented EDD determines eligibility, regardless of the actual birth date, as some births may occur before or after the estimated date. 

Sharing is limited to $150,000 for any pregnancy event, including antepartum care, delivery, and complications to the mother, and postpartum care (this is applied regardless of the number of babies the mother is carrying during the pregnancy event).

Maternity care is usually billed as one global bill that includes prenatal visits, standard delivery costs, postpartum care, and any complications for mother and/or child during that same “pregnancy event.” 

Because maternity care is typically billed as a single global maternity bill (including prenatal, delivery, postpartum together), Impact expects one comprehensive bill per pregnancy. If you begin care with a midwife and later transfer to a physician—or vice versa—sharing still applies to the one provider who submits the global bill.

Note: If you begin maternity care with a midwife who submits a bill, and you later switch to an OBGYN, a new bill cannot be submitted for sharing. Only one global bill per maternity event is eligible.

For ineligible maternity events, any fetal abnormalities and/or congenital abnormalities noted in medical records prior to the mother joining Impact Health Sharing, will be considered a pre-existing condition and would not be eligible for sharing.

To be eligible, delivery must be performed by a Medical Doctor, Doctor of Osteopathy, or a licensed Midwife.

A newborn can be a member effective from the date of birth, provided the request is submitted within 30 days of the date of birth. Requests to add newborns to membership cannot be backdated more than 29 days.

Click Here For our Maternity Guidelines