Doula Coverage: Does it exist?

Navigating the complexities of healthcare benefits can be daunting, especially for specialized services like doula coverage. Doula care can significantly impact the prenatal and postpartum journey, providing crucial support and guidance during childbirth. We'll explore two critical aspects of doula coverage: Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs) eligibility and the growing trend of employer-enhanced benefits that support families in accessing doula and maternity care. Additionally, we'll shed light on the current state of private insurance coverage for doula services and how it's changing the landscape of childbirth support.Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs) are financial tools that allow individuals to save on a pre-tax basis for qualified medical expenses. Whether these accounts can cover doula services depends on various factors, including the details of your FSA or HSA plan and the regulations in place. Here's a general overview:

Flexible Spending Accounts (FSAs) for Doula Coverage*:

Eligibility: FSAs are a common component of employee benefits packages, allowing workers to contribute pre-tax dollars into the account for medical expenses.

Covered Expenses: While FSAs typically cover a broad range of medical expenses, the specifics can vary depending on the plan. Generally, expenses deemed medically necessary and prescribed by a healthcare provider are eligible. However, including doula services as qualified expenses may differ from one plan to another.

Letter of Medical Necessity: In some instances, to use FSA funds for doula services, you might require a "Letter of Medical Necessity" from your healthcare provider. This letter explains why doula services are medically necessary for your unique situation.

Check with Your Plan Administrator: To ascertain whether your FSA includes doula services, it's imperative to consult your plan administrator or review the plan documents provided by your employer. They can offer precise information about eligible expenses under your plan.

Health Savings Accounts (HSAs) for Doula Coverage*:

HSAs are tax-advantaged savings accounts for individuals with high-deductible health plans (HDHPs). These accounts can be used for qualified medical expenses. Still, the rules governing eligible costs are similar to those of FSAs.

Eligibility: HSAs are tax-advantaged savings accounts for individuals with high-deductible health plans (HDHPs). What's advantageous is that HSAs are individually owned, allowing you to open and contribute to one even if your employer doesn't offer it.

Covered Expenses: Similar to FSAs, HSAs can be used for various eligible medical expenses. Whether doula services are deemed eligible hinges on your specific plan and their medical necessity.

Letter of Medical Necessity: Even if your HSA plan permits the use of HSA funds for doula services, you might still require a Letter of Medical Necessity from your healthcare provider to establish the medical necessity of these services.

Check with Your HSA Provider: If you possess an HSA and contemplate using it for doula services, reaching out to your HSA provider is imperative to understand their unique rules and prerequisites.Whether FSA and HSA benefits cover doula services depends on your specific plan and may require documentation of medical necessity. Always check with your plan administrator (for FSAs) or your HSA provider to understand the rules and eligibility criteria for using these funds for doula services. Also, consult your healthcare provider to determine if they can provide the necessary documentation.

Employer Enhanced Benefits for Doula Coverage*:

In today's competitive job market, businesses increasingly recognize the importance of offering comprehensive benefits to attract and retain top talent. Among these benefits, family-focused healthcare options are gaining significant attention. As the demand for holistic support during the prenatal and postpartum periods grows, several innovative health benefit providers are stepping up to cater to the unique needs of families, particularly when it comes to doulas and maternity care. Target, CVS, Microsoft, PNC Bank, and Walmart are a few forward-thinking employers offering health benefit providers dedicated to empowering families with the care and support they deserve.

1. Carrot Carrot is a leading family planning and fertility benefits platform. While their primary focus is fertility-related services, some employers using Carrot may include doula support as part of their family planning and maternity benefits. Doula support during childbirth can significantly reduce stress and enhance the overall experience for expectant parents, making it a valuable addition to any maternity benefits package.

2. Birthsmarter Birthsmarter is a company dedicated to providing benefits and education related to pregnancy, childbirth, and postpartum care. Some employers partner with Birthsmarter to offer doula support and education to their employees. By including Birthsmarter in their benefits package, employers show their commitment to supporting their employees through childbirth.

3. Stork Club Stork Club offers a comprehensive approach to maternity benefits. They provide a range of services, including doula support, to help employees navigate the challenges of pregnancy and childbirth. Stork Club's holistic approach ensures that employees receive the support they need throughout the maternity process, from prenatal care to postpartum recovery.

4. Progyny Progyny is a healthcare company specializing in fertility and family-building benefits. Employers can collaborate with Progyny to provide comprehensive maternity benefits that may include doula support. By choosing Progyny, employers empower employees to access the best possible care during pregnancy and childbirth.

5. Maven Maven is a digital healthcare platform that offers a wide range of family planning and maternity services. Employers can use Maven to provide employees with access to doula support and virtual consultations with healthcare professionals. This flexibility ensures that employees receive the care they need, no matter where they are.

6. Kindbody Kindbody is a women's health and fertility company that offers holistic care to support women through various life stages, including pregnancy and childbirth. Employers partnering with Kindbody can offer doula support as part of a comprehensive maternity benefits package, emphasizing their commitment to employee well-being.

7. Peppy Peppy's platform focuses on employee well-being, including maternity and family support. Employers can leverage Peppy to provide doula support and guidance to their employees, helping them navigate the challenges of pregnancy and childbirth with confidence.

8. Sapyen Sapyen is a forward-thinking benefits platform that allows employers to tailor their benefits offerings to the unique needs of their workforce. Employers can include doula support as part of their benefits package through Sapyen, promoting a supportive and inclusive workplace culture.

9. Univfy Univfy is a fertility benefits provider that offers a range of services to help employees build their families. Employers can work with Univfy to offer doula support as an integral part of their maternity benefits, ensuring employees receive personalized care during childbirth.

10. Virtus Health Virtus Health is a global leader in fertility and maternity care. Employers can partner with Virtus Health to offer comprehensive maternity benefits that may include doula support. This partnership reflects a commitment to providing top-notch care and support to employees on their journey to parenthood.

As employers strive to create a more inclusive and supportive workplace, offering comprehensive healthcare benefits that include doula coverage for childbirth is a powerful way to demonstrate care for employees' well-being. These health benefit providers are paving the way for businesses to support their employees during one of life's most significant moments. By partnering with these innovative providers, employers ensure their employees can access the best possible care, fostering a healthier, happier, and more engaged workforce.

Private Insurance Coverage for Doula Coverage*

Rhode Island is the only state requiring private health insurance companies to cover doula care. In 2021, RI became the first state to require doula coverage in private health insurance plans. This law applies to all fully insured commercial health plans offered by a Rhode Island licensed insurer issued after July 1, 2022. Rhode Island anticipates expanded access to doulas, improved labor and birth outcomes, and decreased insurance costs. Other states are considering expanding private coverage of doula care with the same anticipated results: CA, IN, MA, MS, NY, and VA. Some major healthcare companies, such as Aetna, BCBS, United Healthcare, Humana & Cigna, have launched pilot programs offering coverage or reimbursement of birth doula costs in some states for Medicaid plans.

Child and Dependent Care Expenses for Doula Care*

The IRS has guidelines to be able to claim child and dependent care that most doula services do NOT fit in to.

PER IRS: "Are These Work-Related Expenses? Child and dependent care expenses must be work-related to qualify for the credit. Expenses are considered work-related only if both of the following are true.

They allow you (and your spouse if filing jointly) to work or look for work.
They are for a qualifying person's care.

To be work-related, your expenses must allow you to work or look for work. If you are married, you and your spouse must work or look for work. One spouse is treated as working during any month they are a full-time student or aren't physically or mentally able to care for themselves. Your work can be for others or in your own business or partnership. It can be either full-time or part-time, and it can be either in or out of your home."Since doulas work with families for birth and postpartum times, the birthing person is not working, nor available for work and therefore doesn't qualify for the Child and Dependent Care Expense.

If you have a doula in your home after you start back to work, please check with your CPA for guidance on coverage. As you navigate the ever-evolving landscape of healthcare benefits, it's essential to stay informed about your options, especially regarding doula coverage. Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs) offer potential avenues to fund doula services, but eligibility and coverage can vary. Always consult with your plan administrator or HSA provider to understand the specifics of your plan. Furthermore, the support for families seeking doula and maternity care is growing, thanks to innovative employers and health benefit providers. Companies like Carrot, Birthsmarter, Stork Club, Progyny, and many others are leading the charge in providing comprehensive benefits that cater to the unique needs of expectant parents. These benefits empower families and foster a healthier and more engaged workforce.

The movement to include doula coverage in private health insurance is gaining momentum. Rhode Island has set a precedent by requiring private health insurance plans to cover doula care. Other states are considering similar measures—major healthcare companies also pilot programs to offer doula coverage or reimbursement in select plans and states.

See our latest blog that dives into "Doula Medicaid Coverage: Benefits and Challenges" HERE.

*Always check with your employer benefits coordinator, health care plans, and CPA for your specific coverage and allowances.

Doula Coverage: Knowing Your Healthcare Benefits