Surrogacy insurance isn’t the most fun thing to think about, but it’s important!

Any kind of pregnancy carries an element of risk to both the mother and the child. In the case of gestational surrogacy, that risk is multiplied due to the nature of Assisted Reproductive Technology (ART). And if anything were to go wrong with the surrogacy pregnancy, even more people would be affected: you, your family, the baby you’re carrying, and the intended parents (IPs).

That’s why before you even begin your journey as a surrogate, you and the IPs must establish that you have sufficient health insurance, maternity insurance, and life insurance that covers all aspects of the surrogacy journey. 

We’ll discuss what your insurance needs to cover, how to find out if your insurance is sufficient, and what to look for in an insurance agency.

Determine if Your Health Insurance Covers Surrogacy

Reputable surrogacy agencies will require their gestational carriers (GCs) to have a health insurance policy in place even before they apply to the program. While major health insurance plans include maternity coverage, not every plan covers surrogacy. Some plans carry an exclusion or leave ambiguity around the topic of surrogacy. Others openly state whether they do or do not cover it.

You must be 100% certain your policy covers surrogacy. But if you’d rather not comb through the fine print of your health insurance policy, ask your attorney or an insurance agent who is familiar with Assisted Reproductive Technology to vet your plan.

If you learn that your health insurance or maternity coverage does not include surrogacy, look for an Affordable Care Act (ACA) plan on the marketplace during open enrollment. Or, if you work with a broker, specify that you want a policy that covers surrogacy. If you can’t get an ACA plan, we recommend Lloyds of London. Lloyds of London writes surrogacy policies and has plans that are open all year, and are available in any state.

Specialty Maternity Insurance through Lloyds of London

Surrogacy insurance, or “specialty maternity insurance,” through Lloyds of London is not health insurance, but it covers the maternity aspects of any claims. In fact, it looks more like property or casualty insurance because it is written as a contractual liability. This means that the IPs are liable to cover the gestational carrier’s medical expenses.

What Should Surrogacy Insurance Cover

The IPs must pay for or carry insurance that will cover the following expenses you might incur:

• Pregnancy — including all your prenatal checkups
• Birth / Delivery — everything related to the birth and delivery of the baby
• Disability, including medically necessary bedrest — If you miss work due to physician prescribed, medically necessary bedrest, then insurance would cover lost wages, childcare and housekeeping.
• Loss of reproductive organs
• Death

Life Insurance

Surrogates and IPs must both have life insurance.

For the gestational carrier, the policy can be written as a term life policy or as an accidental death policy. The difference between these two policies is who receives the benefits in the unlikely situation that a gestational carrier would die during the pregnancy.

• Term Life Insurance: if the gestational carrier dies, the benefits go to the beneficiary named by the gestational carrier.
• Accidental Death: if the gestational carrier and the baby die, $100K would go to the IPs and can only be used to restart the surrogacy process. 

Another type of insurance we recommend is Rider Insurance. This further protects the IP financially. If there is any loss to the gestational surrogate of her reproductive organ(s) or a permanent disability as a result of the surrogacy, then the IPs are liable. Rider Insurance would cover the intended parent in this situation and would pay the damages to the gestational carrier. Rider insurance can be added to an Accidental Death policy but not a Term Life policy.

Insurance Conversations You Should Have with Your Insurance Agent

You have a lot of details to keep track of — and probably a lot of questions running through your mind now! Use the following checklist to make sure all the details are in order.

• Your preference of hospital, clinic, or doctor.
  Be sure all parties and the insurance company are aware of your preferences so they can clarify what is available, or work with you to find a suitable replacement.

• Discuss how your current insurance will work with any new insurance being purchased for you.

• Ask what happens to the term life or health insurance policies after delivery, or how you could keep them after your contractual obligation is fulfilled (typically after delivery of the baby). If you can keep term life, for example, ask your agent how to do that.

• Make sure you understand who is paying for which policies.

• Know what to do with any notices you’re given or that arrive in the mail. (Spoiler alert: Forward any and all notices and letters you receive to your surrogacy agency.)

Most agencies will require you to send them any and all documents, bills or letters you receive from the insurance company or the medical provider. Even if you don’t think it’s an important document, forward it! This is part of your contractual obligation.

Your insurance agent, IP, and surrogacy agency don’t receive any of these notices. If you don’t forward these bills and notices in a timely manner, you could be liable for paying the bills. The last thing you want would be for an insurance account to become delinquent because a bill wasn’t received by the IP.

Check your mail and don’t automatically toss letters into the recycling bin. Add the insurance accounts to your “Safe Senders” list so your email filters don’t move them to junk mail.

• Ask questions.
  Even though your IPs are responsible for paying for the insurance, it is your policy.  Whatever questions you would normally ask on your behalf when opening a new account, ask them to your insurance agent as well.
• Know what’s being purchased and why it’s important. An insurance agent who is familiar with surrogacy will be happy to answer your questions.
• Understand the purpose of any HIPAA release you are asked to sign.
  Ask what it’s used for and make sure you’re comfortable with the wording so you feel protected. Don’t just hand over personal information to an outside party without understanding why.

At this point, all of these questions and types of insurance may seem like a lot. We agree! That’s why we urge our surrogates to work with an insurance agent who is familiar with ART, including surrogacy.

How to find an insurance agency that specializes in surrogacy:

1. Ask your surrogacy agency, attorney or reproductive endocrinologist for a referral. They will have experience working with several insurance agents and will know who is trustworthy, knowledgeable and easy to work with. You can be confident in their recommendation as agencies cannot offer referral fees or bonuses.
2. Explore professional organizations. Your insurance agent may belong to the “Society for Ethics in Egg Donation and Surrogacy” (SEEDS.org) or “Men Having Babies” (menhavingbabies.org). Contact these organizations, or even your escrow company, for a referral.
3. Visit online surrogacy boards (such as Facebook groups, Reddit). Ask other people who they used and what their experience was like.

Choose an agency that will advocate for YOU, the gestational carrier. Ask them what happens if there is an issue, such as, if you receive a bill that your insurance plan should cover. Be sure your agent will be available to help you when placing the policy AND long after. Regardless of who is paying for the policy, your insurance agent should be on your side!

Red Flags to Watch For

When you’re vetting an insurance agent or agency, consider the following:

• They have been in the community for less than 5 years. If they haven’t been open for 5 years or more, chances are their experience is limited and they could miss something important.
• They are not licensed in all 50 states. Be sure the agency is fully licensed where the policy is being sold.
• They only represent one insurance company. Insurance is not a “one-size-fits-all” solution. An insurance brokerage or agency can piece together the best options for you if they represent several insurance companies.

Frequently Asked Insurance Questions

How Much Life Insurance Do You Need?

We recommend surrogates have at least a $250K policy, although some women choose to increase that amount to $500K.

Who applies for and pays for the insurance?

For all policies except Term Life and Affordable Care Act health insurance, the IP will apply for and pay for the insurance.

What if my insurance changes during the surrogacy process?

If your insurance changes (for example, if your spouse changes jobs or gets a different insurance plan), notify your surrogacy agency and insurance agent right away. Share documents with them such as a summary of benefits. You (or the agency) should also notify the IPs so they are aware they may need to pay a higher insurance premium.

If your agency or insurance agent discovers your new insurance doesn’t cover surrogacy, they’ll look for other options that will protect you and the intended parents.

If the language in your policy changes and no longer supports surrogacy, then apply for a new ACA policy during open enrollment. If you’re not able to get an ACA policy, get a backup maternity policy from Lloyds of London.

An insurance change may cost the IPs more than they were anticipating, but it will still cost less than paying for the full pregnancy out of pocket.

The more advance notice you can give to everyone, the better!

A Note to Intended Parents

What surprises intended parents the most about insurance for surrogacy is the cost. Out-of-pocket costs maximums can be as high as $9,000, and between $15-20K for pregnancy. The Affordable Care Act did not necessarily make insurance affordable — but it is still more affordable than paying for the entire pregnancy out of pocket. Outside of the ACA, the medical costs of pregnancy and delivery are between $25K – $30K for a single pregnancy, and $25K – $35K for twins.

While it’s our hope you don’t need ALL of these types of insurance, maintaining these policies can save you from major expenses and future stress.

Surrogacy Insurance Checklist

Insurance Type	What it Covers	Who it Protects	Who Applies	Who Pays	Who is the Beneficiary	Date Applied	Coverage Start Date	Provider
Life	If you die, your beneficiaries receive payment to help cover their expenses	Intended Parents, Gestational Carrier	Both	IP	As stated in the policy
Term Life		Gestational Carrier	Gestational Carrier	IP	Beneficiary indicated by the GC
Accidental Death		Intended Parents	IP	IP	IP, but only to restart the surrogacy process
Health	All healthcare related appointments	GC	GC	IP	GC
Maternity	All appointments related to the pregnancy	GC	GC	IP	GC
Bedrest	If placed on medically necessary bedrest, this policy would cover the cost of lost wages, housekeeping, and childcare	GC	IP		GC
Rider	Any loss to the Gestational Surrogate of her reproductive organ(s) or a permanent disability as a result of the surrogacy	Intended Parents — without this plan, they would be liable to pay the GC out of pocket	IP	IP	GC