Southeast Insurance Solutions, Inc.
Southeast Insurance Solutions, Inc.
2137 Chatham Avenue
Charlotte, NC 28205
Phone: 704-560-8972
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Maternity Coverage in North Carolina

Starting a family is a wonderful experience that many people experience daily. However the cost of having children can be very stressful from a financial point of view. How are the medical costs of having a child going to be covered? This is why having maternity coverage in North Carolina for most families is essential to keeping their costs down and being able to afford childbirth. And obviously there is much that needs to be covered. From vitamin, to pre-natal care, to the OB/GYN visits to labor and delivery. Knowing how and if your plan will cover these will releive a lot of stress during this already stressfull yet very exciting time.
Let's look at a couple of ways you can get assistance with maternity costs.
  • Are you covered under a group plan?
In North Carolina, maternity charges are usually covered under an employer sponsored health plan. Because your employer is covering the majority of your monthly premiums as part of your benefits package, this is usually your best option for having your maternity expenses covered by insurance.
  • What if you buy your own North Carolina health insurance and don't have access to a group plan? 
Currently there is only one carrier that offers maternity coverage in North Carolina (as long as you are not currently pregnant) with their individual North Carolina health plans.   This rider is optional and works typically like group coverage.  Maternity services are covered under the core health plan's deductible and coinsurance (many carriers in other states have a separate maternity deductible). If you have an individual health plan provided by a major carrier and are planning to start a family, you may want to consider changing carriers to pick up this option. Contact us today for further details on the carrier, plan, and exactly how the rider works to see if this option makes sense for your situation.
  • Get a High Deductible Health Plan (HSA)
Another means of financing maternity would be through a qualified  North Carolina Health Savings Account plan. Because maternity charges are a qualified medical expense you can save money into your HSA to pay for claims.  This means you are using tax deferred money (a savings of 20-40% depending on your tax bracket) for your maternity expenses. This is an excellent way of self financing your maternity charges.
What are the "typical" expenses for maternity in North Carolina?
In 2007, a major health insurer in North Carolina reports that the average maternity charges they received was just around $20,000. This will vary for each person and takes in all claims that were submitted.
The chart below are charges that were taken from a friend's Explanation of Benefits (EOB) statements in 2009.  This was a natural childbirth with no complications and normal 2 day hospital stay in Charlotte, NC. (Note: This is only for illustration purposes. Your charges and discounts may vary by a number of factors).
  Billed Amount Carrier Negotiated Amount
Prenatal Care    
Initial Visit $179 $135
Ultrasound $268 $163
20-week visit $55 $36
Ultrasound $333 $182
Lab Services $93 $21
36-week visit $55 $36
Lab Services $124 $7
Ultrasound $240 $155
Total Prenatal $1,347 $736
Hospital/Delivery Charges    
Anesethsia (Epidural) $2,500 $650
Private Room $1,576 $1,292
Drugs $561 $460
Medica/Surgical Supplies $17 $14
Lab Services $73 $60
Delivery Room $2,734 $2,241
Doctor Charges $3,926 $2,812
Total Hospital/Delivery $11,388 $7,530
Total Maternity Charges $12,735 $8,266
As you can see the cost of childbirth is quite expensive.  The above example is a best case scenario.  If you had to have a ceasarian section and additional additional nights stay in the hospital these total expenses would likely be closer $20,000.  
What if you are already pregnant?
If you are currently pregnant and looking to get new health insurance coverage, most health insurance companies will not cover you until the pregnancy is complete.  One major health insurer in North Carolina will offer you covereage, however you will not be able to add the maternity rider (which means no pregnancy coverage except for complications of pregnancy). You can also contact Medicaid to see if you qualify. If you do, this will cover your costs and many times they will loosen their rules some if you are pregnant.  
If Medicaid is not an option, you may qualify for the North Carolina high risk pool, Inclusive Health.  This is a guaranteed issue program for individuals that do not qualify for private insurance and don't have access to a group plan.  There are eligibility requirements that you need to meet to qualify.  I suggest you contact us so that we can explain your options and assist you in getting covered.
For more information or to go over your concerns, please contact us at

Southeast Insurance Solutions, Inc.
2137 Chatham Avenue
Charlotte, NC 28205