Our New Baby and Health Insurance: What’s Covered?

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Have you ever looked up how much it costs to give birth in the US? Hint: It’s expensive.


According to a new study, the cost of giving birth in America is now more than the average month’s salary. 


So when I found out that Josh and I were expecting, a whole new world of health insurance was opened to me. 


I knew my company had excellent insurance benefits, but I didn’t know the inner workings of my insurance. I’m currently on the CDHP plan with an HSA. 


A CDHP, or Consumer Directed Health Plan, is a high-deductible plan paired with a HSA, or a Health Savings Account. That means that I don’t have a monthly insurance payment, but my deductible is higher and has to be met before my insurance will pay anything. 


I switched to the CDHP plan from the PPO plan last year. With PPO, or Preferred Provider Organization plans, you have a monthly payment and your deductible is lower. Since we became debt free, we opted for the higher deductible with no monthly payment. 


So what happens when you put a baby in the mix and it turns into the family plan? 

As you can imagine, that brought up a lot of questions around baby Williams: 

• Will the birth be covered under my insurance? 
• When will we have to switch to the family plan? How much will we have to pay? 
• What is the best way to insure our new bundle of joy? 
• Can we all be on the family plan?If not, whose plan does Baby Williams go on? 
• When does my deductible reset? 

 I spent some time talking with my company's HR department and my insurance company to answer ALL of my questions. If you’re expecting, you should do the same! Make sure you understand your benefits before giving birth.  

My insurance situation is a little different than most households. Josh and I work at the same company, which means we have separate insurance plans. 

Unfortunately, our company doesn’t allow you to be an employee and a beneficiary. Thus, we have to have our own plans. 

That means the baby has to be on one of our plans. #bummer 

• Family plan deductible: $3,000 
• Individual plan deductible: $1,500 


If one of us didn’t work at the company, we’d all be covered under the family plan with a $3,000 deductible. 


Since that’s not the case, whoever covers the baby will need to meet the $3,000 deductible and the individual will have to hit the $1,500. 


We’ll have to pay $1,500 more, as there is no other option from our employer. 


HR provided valuable information, but for all of those specific questions above, they referred me to my insurance company. Anthem answered all of my questions, and gave me peace of mind when it came to the birth of my son. 


Here are all of the answers: 


Will the whole birth be covered under my insurance?

The birth and hospital stay will all be covered under my individual plan. 


The cost will be $0 because I’ve already hit my deductible. 


If Baby Williams ends up in the NICU, that would be covered under the family plan and we would need to hit the $3,000 deductible before insurance pays anything.  


When exactly will we have to switch to the family plan? And how much will we have to pay?


Our insurance requires Baby Williams to be added within 30 days of birth. 


That’s when our plan will change to the family plan. If the baby goes under my insurance plan, we would need to fulfil the remainder of the $3,000 deductible - $1,500. 


If the baby is added under Josh’s insurance, the full $3,000 would need to be satisfied.  


What is the best way to go about insuring the little one?


 It’s really up to us, but we have to pick who’s insurance plan Baby Williams will go on.


Right now it makes sense for the baby to go on my insurance plan. There’s a lot of things up in the air though, so we’ll see what we decide.  

When does my deductible reset?


My deductible resets August 1st. I initially thought it was May 1st. With my April 27th due date, I was worried that I would give birth in May and have to hit my deductible before any birthing costs were covered. This really worked out in our favor and gave me a big sigh of relief.


I was impressed with how helpful Anthem was. I thought it would be like pulling teeth to get my specific questions answered. 


There were a few things the representative had to double check on, but for the most part, she knew the answer right away. 


The representative even pointed me to a cost estimator, where I entered my hospital and birth type, and it gave an estimate of what I’m expected to pay. 


A vaginal delivery at my hospital costs $14,545. Shocking to see how much childbirth costs! 


Fortunately for my family, I won’t owe anything since I’ve already hit my deductible.


A C-section delivery at my hospital costs $15,215. I was surprised by this number. I thought it would be much higher than a vaginal delivery - since it’s surgery.



I am beyond grateful that Josh and I work for a company that values the work- life balance and backs that principle up with benefits. My maternity leave will be 12-14 weeks depending on how my son is delivered. If you deliver vaginally you are given 12 weeks of leave. A C-section is 14 weeks.  


How am I getting paid during maternity leave?

The most confusing part of the maternity policy is the breakdown on how I will get paid during my time off. 

The first benefit I’ll receive is Anthem Short-Term Disability, which covers 65% of my weekly wages for 6-8 weeks - depending on how the baby was delivered. To “top up” my pay, my company provides Pregnancy Recovery Leave for moms who have given birth for up to 8 weeks. Both of these together cover my full salary for the first 6-8 weeks.  

What about the other 6 weeks? My company provides Parenting Leave, which is 6 weeks of paid parenting leave that must be taken within 1 year of birth or adoption and can be used in 15 minute increments.

 What about Josh? Does he get paid paternity leave?   

In the US, being granted paternity leave is a rare gift, not a common benefit. Under the Family and Medical Leave Act, federal law grants fathers or other secondary caregivers up to 12 weeks of unpaid leave, but the majority of fathers take off only 10 days or less, if they take any time at all.

In comparison to the abysmal ‘average,’ Josh will have 6 weeks of paid paternity leave provided by our company through the Parenting Leave policy. It must be taken within 1 year of birth or adoption and can be used in 15 minute increments.

It’s common for fathers at our company to take a few weeks off and then save the rest of the Parenting Leave for Doctor's appointments, illness, or those nights where you really didn’t get much sleep.

As of right now, Josh plans to take the full six weeks right away to maximize time with our newborn. We’ll play it by ear and make that decision as a family when the time comes.

My Biggest Piece of Advice 

When you find out you’re expecting, there’s so much new information that you need to learn before you welcome your baby to the world. This can be intimidating and overwhelming for any new Mom. Just mention insurance, and blood pressure seems to spike in everyone.

Two of the most important parts of being pregnant is finding out what your insurance covers and what your maternity/paternity leave looks like.

My experience with HR and my insurance company was exceptional. All of my questions were answered and I was even directed to tools that will help me in the future. 

I urge all new parents to take a day and thoroughly go through your options. Don’t be afraid to spend time getting all of your questions answered.

Your budget and your baby will thank you. 

Have you looked into your company's policies? How do they compare to the average? 


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Welcome!

I'm Amanda. My husband and I paid off $133,763 of debt in less than four years! During our journey, I realized what my true passion was in life: helping others become debt free and reach financial independence. You can learn more about us here.

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      About Amanda Williams

      Amanda Williams is owner and founder of Debt Free In Sunny CA: A company inspiring financial literacy and debt free living. Josh and Amanda paid off $133,763 of debt in 3.7 years. She has built a dedicated, engaged, and loyal audience of over 65,000 people from the ground up. The #debtfreecommunity hashtag was created under Amanda's direction and has generated an online movement, bringing thousands together on a daily basis.