First, let’s define PPO.  A PPO is a “preferred provider organization” is a hybrid of a discount and insurance program.  It is often highly favored among consumers as the type of health insurance that provides the highest level of benefits and most personal freedom to visit any doctor you would like.  A PPO is very different from an HMO or an indemnity plan, as will be described next.

How A (Preferred Provider Organization) PPO Works

The two most important things to understand about a PPO are in-network and out-of-network (OON) benefits.

In-network benefits are from doctors, pharmacies, hospitals, and other healthcare organizations that have partnered with your insurance company to provide you with high-quality care at a discounted rate.  Not only is the overall rate less expensive, but the percentage that you have to pay is often much less (10% to 20% of the total bill is standard).  It is greatly to your benefit to remain “in-network” to be sure that you have to pay the LEAST amount out-of-pocket and will receive the highest level of health insurance benefit. A PPO is named because these “in network” professionals are “preferred” and your health insurance company, ideally, wants to receive all of your care from these preferred providers.

Out of Network PPO

Out-of-network (OON) means that with a PPO, you are free to see any healthcare provider you would like.  If you would to see a doctor out-of-network, your health insurance will still pay for some of it (about 50% is standard), but you will be responsible for a greater portion of the overall cost.  Also, the overall cost is often much higher than in-network because these providers have not agreed to offer a discounted rate.  If you receive care OON during an emergency, you can petition the health insurance company to pay on an in-network basis.  Other than this situation, it is much to your financial benefit to remain in-network when choosing where to get your healthcare.

During pregnancy, you want to spend your money on cute clothes for the little one and fun toys for the nursery, not expensive maternity insurance premiums.  However, we all know the value of high quality medical care – especially during this period, where your baby is growing so rapidly!  Monthly visits to the OB/GYN and delivery (let alone a C-section!) can easily cost more than $6000 to $10000, so having some type of health insurance during pregnancy is vital.

Finding Inexpensive Maternity Insurance

For women that are not covered through health insurance, there are inexpensive maternity insurance plans that cover medical care related to birth, delivery, and immediate post-natal care, then cease after birth.  Because you only hold this insurance policy for 9 months or so, the rates are often inexpensive enough for the average expectant mother to have without “breaking the bank!”

Rates For Maternity Insurance

The rate or cost of maternity insurance is often based on several factors, including how far along the pregnancy is, your previous pregnancy history, your overall health, and the level of coverage that you would like.  The following factors will result in lower premiums.  Obviously, some of them you can control and others are out of your control:

1. A single birth.  It is fairly obvious that if you are carrying twins or more, your premiums are going to be more.

2. Your previous births.  If you have previously delivered multiples or have had a C-section, your premiums are likely going to be more expensive.

3. Your health status.  Take steps to make yourself an ideal candidate – quit smoking, get your weigh in to a healthy range, and eat a healthy diet.  This will make you a favorable candidate and premiums will be lower.

4. “Discount” plans are the least expensive and require you to pay for doctor bills out of pocket, but give you a significant discount, up to 75%.  You will pay much less in premiums with these types of plans.

While “affordable health insurance” may sound like a myth, it actually does exist.  There a number of health insurance products that are available without a medical checkup that are also affordable.

First Step to Affordable Health Insurance

First, let’s address why an insurer would want to conduct a medical checkup.  By determining pre-existing conditions or risk factors, the insurer can charge you a higher premium to protect themselves against future risk and loss.  Without a medical checkup, the insurer must rely on one of two things – honesty on the written application or a standard rate across the board, regardless of your medical condition or history.  When an insurer gives a standard rate, this is called “group health rate” because it is theorized that for every person that is extra risky, there are other people that are less risky, and that risk will “even out” in the end.

Get Health Insurance With No Medical Checkup

Affordable health insurance with no medical checkup is something that can be purchased.  One option you have is to purchase a high-deductible plan that essentially only covers catastrophic medical care such as a ruptured spleen or broken bone.  For young, healthy individuals, this may be a wise option.  The premiums are very low.  However, the benefits are also low and do not cover things such as doctor visits or diagnostic tests.

Another option is to become part of a “group plan.”  In most states, insurance that is offered through an employer (even if only 2 people work for the organization) counts as “group plan” insurance and does not require a medical checkup for enrollment and full benefits.  Many states also offer large “group plan” insurance that individuals can buy in to without a medical checkup.  Check with your state’s Department of Health and Human Services.

Finally, remember that with impending health insurance reform, more and more states will be likely to offer a group rate plan in the future without the need for a medical checkup.

In America, over 40 million individuals are uninsured.  While many of these people may not need access to medical are on a regular basis, the need for constant medical care arises when one is pregnant.  If you find yourself pregnant and without insurance, one option you have is to purchase maternity health insurance.  This is a health insurance plan that will cover pre-natal care and labor/delivery – a very important insurance to have, given that the average delivery can cost $7000 plus.  Maternity insurance can be purchased after you find out you are pregnant, but often carries a lower monthly premium if you purchase before you become pregnant.

Details About Maternity Health Insurance

The specific details of maternity health insurance will vary from company to company.  Some of these “insurances” are actually discount plans, which provide you with a discount of 10% to 50% for services that you need.  Others are “full service” insurance plans and work the way standard insurance plans work, with little or no out-of-pocket expense on your part for doctor or hospital services.  Depending on the level of care that you desire, you can opt for a discount-type plan for a smaller monthly premium or elect a more comprehensive plan for a higher level of insurance.

Maternity Health Insurance Coverage

Given that you will need to see a physician at least once per month for 9 months, have many diagnostic tests such as blood work or ultrasounds, and a stay in a hospital, it is easy to see how maternity health insurance would be a financially sound decision for women that are otherwise not covered by health insurance during this time.  Proper medical care during pregnancy and birth can prevent complications for both you and your baby for years to come.  Maternity health insurance provides one benefit that is “priceless” – peace of mind.