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15
Jul

Carriers Pay Maternity

Written by dreilly. Posted in Blog, education, health care reform, income protection

Maternity benefits are eligible events in most short term disability policies. They fall under the illness schedule as opposed to the injury or accident schedule (even if the pregnancy occurred accidentally!) Policies begin to pay claims after a waiting period for either type of event. Payments for injuries or accidents usually begin before illness events. For example, a policy may offer income payments as of the first day of an accident while the policy may require a one week wait before payment for an illness. Waiting periods differ from policy to policy.

Under most policies, maternity claims are generally payable for a maximum of six weeks from the date of the delivery. This is standard industry practice based upon general medical guidelines. Complicated deliveries and extenuating medical conditions can of course allow for an extension of claims.

Here’s a quick class. If a policy requires a one week waiting period before payments begin, and if a participant stops working on the actual day of the delivery, then the plan will begin the waiting period on the date of delivery, which leaves the participant with only five weeks of eligible claims left of the six available. But considering many doctors send participants home for bed rest before the expected date of delivery, the maximum benefit changes. This is because the waiting period begins on the day the member is sent home as opposed to the date of delivery. For example, if the plan requires a one week wait, and if a doctor sends the member home one week prior to the delivery date, then the member has the opportunity to satisfy the waiting period while at home before the delivery date. The policy will then still pay the industry standard maximum of six weeks once the delivery occurs.

Similarly, if a participant leaves work four weeks early for bed rest due to doctor’s orders the policy will then pay a maximum benefit of nine weeks of claims. This is because the member satisfies the one week waiting period starting from the date the member went home. Claims payments then begin three weeks before the delivery date while the member remains unable to work at home. Once the delivery occurs the policy will still pay the industry standard maximum of six weeks once the delivery occurs.

To simplify…. just remember that maternity claims are generally paid for six weeks from the date of delivery. The policy waiting period starts as soon as the member takes leave. If the leave occurs before the delivery date, then the member receives more weeks of payment. If the leave occurs on the delivery date, then the member receives fewer weeks of benefit.

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