ACA Open Enrollment and Surrogacy
11/06/2023Certain policies will cover a pregnancy where the woman intends to raise the child but have a clawback clause seeking reimbursement for covered services associated with a surrogate pregnancy when the surrogate receives monetary compensation. If you’re planning a 2024 surrogacy journey and your gestational carrier’s current insurance policy does not cover surrogacy, Open Enrollment on runs from November 1 to January 15. Consumers who enroll by midnight on December 15 (5 a.m. EST on December 16) can get full-year coverage that starts January 1, 2024.
Below is a sample of a clause to be aware of:
Traditional or Gestational Surrogacy
In situations where you receive monetary compensation to act as either a traditional or gestational surrogate, Health Plan will seek reimbursement for covered Services you receive that are associated with conception, pregnancy and/or delivery of the child, except that we will recover no more than half of the monetary compensation you receive. A surrogate arrangement is one in which a woman agrees to become pregnant and to surrender the baby to another person or persons who intend to raise the child. This section applies to any person who is impregnated by artificial insemination, intrauterine insemination, in vitro fertilization or through the surgical implantation of a fertilized egg of another person and applies to both traditional surrogacy and gestational carriers.
Note: This "Traditional or Gestational Surrogacy" section does not affect your obligation to pay your Copayment, Coinsurance, and/or Deductible for these Services. Within 30 days after entering into a Surrogacy Arrangement, you must send written notice of the arrangement, including all of the following information:
- Names, addresses, and telephone numbers of the other parties to the arrangement.
- Names, addresses, and telephone numbers of any escrow agent or trustee.
- Names, addresses, and telephone numbers of the intended parents and any other parties who are financially responsible for Services, the baby (or babies) receives, including names, addresses, and telephone numbers for any health insurance that will cover Services that the baby (or babies) receives.
- A signed copy of any contracts and other documents explaining the arrangement.
- Any other information we request in order to satisfy our rights.
