Surrogate Maternity and Cycle Medical Plan
PLAN DESCRIPTION:
Providing insurance coverage specifically for a surrogate pregnancy or an IVF pregnancy and complications that may arise during the IVF synchronization cycle with you, or the egg donor and surrogate.
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Medical Plan Premium And Deductible
CREDIT CARD PAYMENT NOW AVAILABLE!
| Medical Plan Choices | SMC Platinum | SMC Gold | SMC Silver |
| Enrollment Fee: | $800 | $800 | $800 |
| Premium: | $2,725 paid per four installments prior to pregnancy. | $1,750 paid per four installments prior to pregnancy. | $1,250 paid per four installments prior to pregnancy. |
| Deductible: | $15,000 Singleton $30,000 Two Fetus. Age 35 and under $25,000 Singleton |
$30,000 Singleton $40,000 Two Fetus. |
$45,000 Singleton $60,000 Two Fetus. |
| Funding of Deductible: | Amount due in full at 6 week ultrasound. |
6 months of deductible payments at $3000.00 each. Initial payment due at 6 week ultrasound. |
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| Surrogate Limit: | US $500,000 negotiated rate US $50,000 in-patient hospital bedrest |
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| Refund of Premium: | 100% refund of Surrogate Maternity PlanSM premium if pregnancy is not medically confirmed less $500 broker/administration fee. | ||
| Credit: | 90% credit to another policy if loss of pregnancy occurs prior to surrogate transfer to the OB. |
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| Coverage Term: | The maternity policy remains in effect for 18 months from the six week ultrasound of pregnancy. | ||
Surrogate Maternity Medical Plan Summary Of Benefits
| Plan Maximum | $500,000 in negotiated coverage. (negotiated coverage is the amount of the claim after PPO Network discounts are applied.) |
| Coverage | One fetus or two fetus' pregnancy and birth. |
| Hospital Expenses | All medically necessary expenses due to pregnancy while in hospital. |
| Hospitalization In Patient Bed Rest |
$50,000 (Maximum amount In-Patient Bed Rest, OBGYN ordered hospitalization, Company preauthorization required). |
| In-Network Payment Percentages |
100% |
| Out of network Payment Percentages |
Coverage is 100% up to the plan maximum of $500,000 in negotiated rates. Clients may be balanced billed for any charges over the negotiated amount. Charges for balance bills do not apply toward any policy maximum. |
| OB Physician Services |
All medically necessary treatment due to pregnancy while in hospital. |
| Ambulance Services | To and from hospital within 100 miles in the same geographic area. |
| Home Health Care | All medically necessary expenses due to pregnancy in accordance to written plan established, approved and followed by a physician. |
| Prescriptions | All medically necessary prescriptions 100% reimbursed by plan. |
| Pregnancy Ultrasounds | Up to 4 ultrasounds per pregnancy, based on medical necessity. |
| Ultrasounds | on medical necessity. |
| Coordination of benefits |
The Surrogate Maternity PlanSM is always primary. |
Cycle Medical Plan Summary Of Benefits
| Premium: | $395 Per Cycle. |
| Deductible: | Zero. |
| Plan Maximum: | $500,000 combined single limit for egg donor and surrogate / recipient. |
| Coverage: | Complications only. |
| Accidental Paralysis: |
$200,000 Combined single limit for egg donor and surrogate / recipient. |
| Accidental Death Benefit: |
$200,000 Combined single limit for egg donor and surrogate / recipient. |
Surrogate Accidental Death InsuranceSM
Plan Description: The Surrogate Accidental Death InsuranceSM is only offered through New Life Agency and is an added benefit within the Surrogate Maternity and Cycle Medical PlanSM.
SAD InsuranceSM is specifically designed to insure both the surrogate's family and the intended parent(s) in the event of death due to surrogate pregnancy or delivery. As any death benefit, it is designed to make the beneficiary's financially whole again.
SAD InsuranceSM Premium and Limits
| Premium: | $395.00 single set premium. |
| Beneficiary Surrogate: | $250,000 designated to surrogates beneficiary. |
| Beneficiary Intended Parent: |
$100,000 designated to Intended Parents as beneficiary. |
SAD InsuranceSM Summary of Benefits
| Coverage Term | 18 months from medical authorization of pregnancy date. |
| Coverage term prior to pregnancy: |
Your surrogate has SAD Insurance of $200,000 combine single limit through our Cycle Medical Plan. |
| Waiting Period: | none |
| Application: | none |
| Exam: | none |
Why Do You Need The Surrogate Maternity And IVf Cycle Medical PlanSM
Surrogate and IVF pregnancy health care costs in the United States are higher than typical pregnancy and maternity costs.
Claims history demonstrates 30% higher claims cost for surrogate pregnancies.
The United States health care system is principally funded through private insurance. Statements from major medical companies have alleged an individual accessing insurance coverage for a surrogate pregnancy is a profit making or third party liability activity that insurance companies are not obligated to pay under the insurance contracts.
Major medical insurance companies may deny any surrogate related claims and several major carriers are updating their booklets to exclude surrogate pregnancies. Therefore, individual or group coverage for your surrogate may be insufficient to cover Intended Parent(s) liability.
For too long the major medical insurance industry has given ambiguous and contradictory insurance information regarding surrogate pregnancies. To avoid ambiguity, disclose on any application for insurance that you are in the surrogacy process or have a written confirmation from the insurance carrier they will specifically pay claims for surrogate maternity and delivery care.
Major Medical insurance companies have the right to review or deny claims up to two years after claim occurs.
Here are good explanations of why you need the Surrogate Maternity and Cycle Medical PlanSM:
1. Potential financial risks.
Starting a family involving assisted reproduction includes greater risks than those faced by other parent(s). The Surrogate Maternity and Cycle Medical PlanSM offers confidence and peace of mind that all parties involved will not be denied for a surrogate pregnancy. New Life Agency specializes in mitigating this kind of risk for the eventualities that could jeopardize the well being of yourself and your new family.
2. Disruption of surrogates'personal policy.
Surrogates will not have to risk denial or cancellation of their personal individual or group insurance plan because of surrogacy related insurance claims.
3. Higher risk on IVF pregnancies.
Claims for Surrogates have a 30% higher claims risk ratio. The Surrogate Maternity and Cycle Medical PlanSM is specifically designed to manage surrogate pregnancy claims.
4. Paying claims for a third party surrogacy agreement is difficult to manage.
All claims will be managed through your Claims Fund AccountSM. Neither you nor your surrogate nor your surrogacy industry professional will ever pay claims directly as long as you stay in network. An explanation of benefits with claims detail is issued every time a claim is paid from your Claims Fund AccountSM and is available upon your request.
5. Claims are aggressively discounted through our Third party administrator.
The claims administrator's duty is to achieve the lowest negotiated rates which will reduce your liability when complications arise.
6. Large network of medical providers.
The network accesses one of the largest PPO medical provider networks in the nation; offering cost savings based on agreed contracted network service provider rates.
7. When your surrogate relocates to a different state you have coverage.
In the event your surrogate may move to a different state the Surrogate Maternity and Cycle Medical PlanSM will manage claims the same as the state she applied for insurance within the network of providers.
8. Refund of Premiums.
If a pregnancy is never achieved, 100% of premiums paid are refunded, less a $500
Broker/ Administration Fee.
Claims Management and Customer Care
New Life Agency Claims Division is a third party administrator providing customer care and claims handling services to Intended Parents and their Surrogates for New Life Agency, Inc.
New Life Agency Claims Division is committed to helping future families created through choice and possibility.
Customer Care Advocate:
Each enrolled member receives unique personalized care. Customer Care advocates are there from the beginning of gestational cycling through the delivery and hospital check out. They assist in every step of OBGYN and Hospital choice and admissions assuring management through your provider process.
Hospital and Physicians:
New Life Agency Claims Division negotiates with all Physicians and Hospitals. The network accesses one of the largest PPO medical provider networks in the nation; offering cost savings based on agreed contracted network service provider rates.
Claims Cost Control:
Saving Indented Parents money is New Life Agency Claims Division's standard. Our standard protocol is to have all claims re-priced through our network, adjudicated, and paid within 30 days providing our clients with the deepest discounts available for their medical expenses.
Sample Savings
| Savings Samples | Total Charges | Negotiated rate | Savings |
| Vaginal singleton: No complications |
$9,491.62 | $1,235.00 | $8,256.62 |
| C-section singleton: With complications |
$40,205.30 | $12,061.59 | $28,143.74 |
| C-Section Two Fetus: No Complications |
$11,746.52 | $5,664.70 | $6,081.82 |
Services Provided
| " | You and your surrogate will have a Customer Care Advocate providing excellent assistance throughout your pregnancy |
| " | Access to provider discounts of up to 60% (0%-60%) on all maternity claims. |
| " | Enrollment processing to include benefits card. |
| " | Program Verification and service calls to providers. |
| " | Access to an extensive PPO network of Hospitals and Physicians in most states. |
| " | Claim processing to include re-pricing and aggressive discount negotiations,if necessary. |
| " | Explanation of Discount provided for each claim clearly detailing the amount due to the providers of service. |
| " | Electronic or Paper notification of claims processed. |
| " | Fully staffed Toll-Free Customer Care Line. |
| " | Assistance in coordination between provider and client to ensure all claims are paid timely and accurately. |
| " | 24 hour emergency hotline. |
Preexisting Limitations And Exclusions
Exclusions:
Triplet or more pregnancies, Newborn Coverage, Amniocentesis Nervous, Mental Disorder.
Pre-Certification:
Not less than 7 days in advanced, of all Medical Treatment except emergency treatment.
Emergency treatment is required no later than 72 hours after admission.
Requirements:
The Surrogate Maternity and Cycle Medical PlanSM application must be accepted and approved by New Life Agency, Inc. underwriters.
In-Patient Bed Rest, OBGYN ordered hospitalization, Company pre-authorization required.
Application must be completed by Intended Parent(s) and Surrogate and accepted by New Life Agency, Inc.
Limitations:
Coverage may be deemed limited or denied by underwriting review.
Application is recommended prior to pregnancy and prior to any medications being administered.
Medical Claims must occur in US.
This Certificate provides limited benefits, and should not be considered Basic Hospital or Basic Major Medical Coverage.
Pre-existing Conditions:
This Policy covers no Pre-existing Conditions.