How are pregnancy medical expenses reimbursed?

Throughout pregnancy and even after childbirth, the mother-to-be must go through different medical exams mandatory related to pregnancy and child health. If the pregnant woman has a vital card and is affiliated with the Primary Health Insurance Fund, most consultations with health professionals are Supported by health insurance. Which medical expenses are reimbursed? What is the care in the event of pathological pregnancy, twin pregnancy or termination of pregnancy?

What examinations are covered during pregnancy?

As part of pregnancy monitoring, compulsory examinations are covered at 100% from the 1st day of pregnancy until the 12th day after delivery. But this remains within the limit of the health insurance tariff, which means that that does not take into account excess fees, which some mutuals (complementary health insurance) can cover in addition. This also applies to twin pregnancies.

The compulsory examinations reimbursed during pregnancy are:

• 7 prenatal consultationsfrom the third month of pregnancy.
• Biological examinations additional: blood tests, urine tests and cervico-uterine smears if you are not up to date at the start of your pregnancy.
• 3 pregnancy ultrasounds every quarter.
• A early prenatal care to discuss your specific needs.
• A prenatal preventive assessment with a liberal or PMI midwife.
• Seven birth preparation sessions and parenthood.
• A oral check-up from the 4th month of pregnancy.
• A prenatal screening for trisomy 21.

In principle, other medical consultations, which are not related to compulsory pregnancy examinations, are reimbursed at the usual rates. Osteopathy sessions are not covered by health insurancebut a supplementary health insurance can cover a supplement if your contract provides for it.

For acupuncture sessions, some acts are covered by health insurance if you turn to a contracted doctor and if you follow the coordinated care pathway (in other words if you have a medical prescription from your doctor). In this case, reimbursement is up to 70% of the consultation. The rest is the responsibility of the pregnant patient.

What care in case of pathological pregnancy?

In the case of a pathological pregnancy or fetal pathology, other medical examinations may be prescribed such as ultrasounds. If they are carried out following a medical prescription, they are therefore covered at 100%, within the limits of the rates applied by health insuranceor for establishments and doctors under sector 1 agreement.

What is the treatment for an aborted pregnancy?

THE medical expenses related to an aborted pregnancy – an early miscarriage during the first trimester – can be billed to health insurance. This includes the consultation with a health professional, the amount of drug treatment prescribed to the patient if necessary and the non-morphological ultrasound of the pregnancy.

How many ultrasounds are reimbursed for a pregnancy?

Three ultrasounds are covered at 100% in general for all future mothers, whatever their situation. The first two ultrasounds are covered at 70% and the third ultrasound is covered at 100%.

What is the care of childbirth?

The costs of childbirth and stay in a hospital or an approved clinic are covered at 100% and reimbursed to the health facility by the health insurance fund. Your delivery fees, your epidural, your living expenses for 12 days (except comfort costs) are entirely at the expense of health insurance. This “hospital package” is valid from the 1st day of your sixth month of pregnancy until the 12th day after delivery. On the other hand, private establishments with excess fees do not give you the right to a higher reimbursement, the same applies to your personal comfort costs.

In addition, be aware that if your state of health requires a emergency transport (ambulance or taxi) to the place of delivery, you can be reimbursed. There single room request is part of the personal comfort costs that are not not covered by Social Security. The amount of your reimbursement will be identical to the hospital rate set by Social Security. But your complementary health can possibly supplement to allow you to pay nothing.

What is the coverage of medical expenses of pregnancy without vital card?

Without a vital card, it is up to the pregnant woman to advance the medical expenses related to the pregnancy examinations. If you are pregnant without being affiliated to the Primary Health Insurance Fund, you will need apply for a temporary social security number. The date on which your rights are granted will be subject to the assessment of your file and your personal situation by your reference CPAM. You may be asked toadvance the fees before being reimbursed if your membership application is too late.