Deductible and copayment during pregnancy: what’s the difference?

Deductible and copayment are two different amounts you may have to pay yourself. During pregnancy, this distinction is important: care may be exempt from the mandatory deductible, while a copayment may still apply.

What is a deductible?

The deductible is the amount you must pay out of pocket first for certain types of care covered by basic insurance. Midwifery care and postpartum care are exempt from the mandatory deductible. That does not mean every bill during your pregnancy is exempt from the deductible.

For example, related medications, laboratory tests, or transportation may still be subject to the deductible. It depends on the specific type of care and the applicable exceptions. The Health Care Institute describes the exemption and any possible additional costs.

What is a copayment?

A copayment is the portion of certain insured care that you are required to pay yourself according to the rules. For in-home postpartum care, a statutory copayment per hour generally applies. This remains the case even though the postpartum care itself is not subject to the mandatory deductible. Some supplemental insurance plans reimburse this contribution in full or in part. See the explanation from the Zorginstituut about postpartum care.

Ask the postpartum care organization for a cost breakdown and then check what your insurance plan covers. Do not assume an amount from a previous insurance year without verifying it first.

What about giving birth in a hospital?

If you give birth in a hospital for medical reasons, there is no statutory copayment for the delivery. If you choose to give birth in a hospital without a medical indication, that copayment may apply. There are exceptions, such as when giving birth with nitrous oxide. Discuss with your midwife and insurer which rules apply to your situation.

The exemption for childbirth does not mean that all additional services are automatically free. Ask which items may be included on the bill.

Is everything I pay out of pocket considered a copayment?

No. An uninsured course, costs exceeding a policy maximum, or a lower reimbursement for care provided by non-contracted providers are other types of costs. A supplemental plan that covers the statutory copayment therefore does not automatically reimburse every amount you have to pay out of pocket.

How do I review a bill?

First, identify the type of care and the date of treatment. Then ask whether the amount relates to your deductible, a statutory copayment, uninsured care, or a difference due to a lack of a contract with the provider. Next, check the terms and conditions for the relevant year.

If anything is unclear, ask for a breakdown before drawing conclusions about coverage. This way, you can specifically verify whether your supplemental insurance reimburses part of the cost.

Also check out the overview of reimbursements during your pregnancy.

Further Preparation

Financial clarity is just one part of your preparation. In the Future Mom Academy online pregnancy course, you can learn more about preparing for pregnancy and childbirth. Check separately to see if the course is covered.