Health Insurance and Surrogacy: What You Need to Know

Intended parents are responsible for the uncovered and uninsured pregnancy-related medical expenses of their surrogate. This makes a surrogate’s health insurance one of the most important, and often one of the most complicated, aspects of a surrogacy journey. Medical care is a significant aspect of pregnancy, therefore, understanding how health insurance applies to surrogacy is critical for both intended parents and surrogates. Proper coverage helps reduce financial risk, ensures access to necessary care, and protects everyone involved.

Why Does Health Insurance Matter in Surrogacy?
The medical expenses of pregnancy and childbirth are costly, and if complications arise, even more so. In the context of surrogacy, medical expenses may be even more complex. Expenses may include:

• Prenatal care and monitoring
• Labor and delivery
• Postpartum care
• Potential complications or emergencies

Without proper coverage, intended parents could face tens of thousands of dollars in unexpected medical bills.

Common Challenges with Health Insurance for a Surrogacy
Not all insurance policies cover surrogacy-related pregnancies. Some policies explicitly exclude surrogacy or have restrictions on coverage. Common issues include:

• Surrogacy Exclusions – Policies that state they will not cover medical costs related to a surrogate pregnancy.
• State-by-State Differences – Insurance regulations vary by state. This can affect what a policy can or must cover.
• Ambiguous Language – Some policies do not clearly state whether surrogacy is excluded, leaving room for disputes.
• Self-funded Plans – Some policies are self-funded, meaning that while a health insurance carrier administers the claims, the surrogate’s employer determines coverage.
• Lien/Subrogation Language – Some policies state they will cover medical costs related to a surrogacy pregnancy but then seek reimbursement.
• Coordination of Benefits – When a surrogate is covered by more than one plan, this process determines how multiple plans share the responsibility for coverage.

*Because of these factors, health insurance policies must be carefully reviewed by insurance professionals before moving forward with a surrogacy arrangement*

What are the Options for Coverage?
There are several options for health insurance for a surrogate. These options include:

1. The Surrogate’s Existing Insurance: In some cases, a surrogate’s personal health insurance will cover maternity expenses related to a surrogacy pregnancy and delivery. However, the policy must be reviewed to confirm there are no surrogacy exclusions or other issues.
2. Supplemental or Surrogacy-Specific Insurance: If the surrogate’s plan does not provide adequate coverage, intended parents can purchase a supplemental plan designed for surrogacy pregnancies. These policies may be purchased through specialized providers, though they may be costly.
3. The Affordable Care Act (ACA) Marketplace Plans: The ACA marketplace may offer coverage for surrogates who do not have an eligible plan or do not have health insurance at all. Open enrollment is each fall, with plans typically having an effective date of January 1 or February 1 of the following year. Qualifying life events may impact timing and trigger a special enrollment period. In some states, pregnancy itself may be a qualifying life event.
4. Medical Complications Insurance: Some products specifically cover unforeseen medical events, such as complications related to embryo transfer. These policies may also be purchased through specialized providers.
5. Newborn Insurance: The surrogate’s health insurance policy should not be used to cover newborn medical expenses, as she is not the parent. Intended parents must secure coverage for their child immediately after birth. In most cases, this is accomplished through the intended parents’ own insurance policy.

How to Navigate Health Insurance in Surrogacy
Due to the complexities of health insurance in surrogacy, due diligence and careful planning is required to ensure all parties are protected. To accomplish this:

• Conduct a Professional Review – Always have an insurance professional review the surrogate’s policy before proceeding. There are companies that specialize in surrogacy-related reviews and products. Depending on the outcome of the review, health insurance options may affect the timing of your surrogacy journey.
• Plan Ahead – Insurance coverage should be in place before the surrogate begins cycling medications in preparation for embryo transfer to avoid gaps in protection. In some states, this is required by law.
• Budget – Even with coverage, intended parents should be prepared for deductibles, co-pays, and other out-of-pocket costs. If an ACA policy or another policy intended to cover medical expenses is purchased, intended parents cover premium payments as well.
• Surrogacy Contract – All surrogacy contracts should include details of the health insurance plan for coverage for the surrogate and outline who is responsible for payment of medical expenses and premiums.

Health insurance is a key component of the surrogacy process. It protects both surrogates and intended parents from unexpected financial burdens. Because policies and regulations vary widely in their treatment of surrogacy, early planning, professional review, and clear surrogacy contracts are essential. By approaching health insurance with diligence and care, intended parents and surrogates can proceed with greater peace of mind and focus on the most important thing: the safe and healthy arrival of a new