Blue Cross Blue Shield of Illinois - Maternity Benefits
Coverage for routine pregnancy expense is optional under all Blue Cross and Blue Shield of Illinois Health Savings Account (BlueEdge HSA plans) and Traditional PPO plans except BasicBlue and SelectTemp. Blue Cross and Blue Shield of Illinois provides a superior maternity benefit for individuals and families. If you're an Illinois resident who needs maternity coverage, but you're not covered under an employer-sponsored plan, Blue Cross and Blue Shield of Illinois is about as good as it gets.
The additional premium for optional maternity coverage is around 40%, but it compares favorably with respect to other individual health insurance plans in Illinois. If the maternity option is not applied for at issue, it may be added post-issue under the following conditions:
- if applied for within 31 days of marriage
- when adding a spouse
- at policy anniversary date
When adding maternity benefits post-issue, evidence of insurability is required; therefore a new application must be completed in full, signed, and dated and there will be a 365 day waiting period. The premium for maternity will be billed if approved.
12-Month Benefit Waiting Period
When you select the pregnancy option, there is no routine maternity coverage during the first 12 months of insurance. After 12 months, maternity is covered the same as any other medical condition (It doesn't matter when the baby is conceived.), subject to applicable co-pays, deductibles and coinsurance.
However, there's a consumer-friendly exception. If you've been continuously insured under a Blue Cross and Blue Shield of Illinois group plan (no more than a 31 day gap in coverage), the time insured under that group plan will offset the 12-month maternity waiting period.
For example, if you were insured under an employer's BCBSIL group health plan for a year or more, and you immediately enroll in a BCBSIL individual plan with the maternity option, you'll have no waiting period for the maternity benefits.
Pregnancy Complications
Blue Cross and Blue Shield of Illinois health insurance plans for individuals and families automatically include benefits for complications of pregnancy. This is a standard plan provision. The optional maternity coverage benefit applies only to routine pregnancy expenses.