In the fall of 2021, I worked with a gym owner in Tennessee who had never offered group health coverage through his own business before. Like a lot of small business owners, he had put it off while he focused on keeping the gym running, and up to that point his family had been relying on his wife's plan through her job teaching for a local school district. We set out to build him a level funded plan with Medical Balance Protection™ from scratch, something his business had never had in place.
While we were putting the plan together, his wife was about eight months pregnant. He and his wife went back and forth for weeks on the timing, trying to decide whether she should stay on her school district coverage through the pregnancy and delivery, or move over to his new business plan before the baby came. There was no obvious right answer in the moment. It was new coverage, it had not been tested yet, and they were deciding whether to trust it with the biggest medical event most families go through. I understood the hesitation. Switching coverage right before a delivery is not a decision anyone takes lightly, and I was not going to tell them it was a simple call. We talked through what the new plan actually covered, line by line, and in the end it came down to how much they trusted the coverage to do what it was designed to do.
They decided to make the move. Effective November 1, his wife came off the school district plan and onto his level funded coverage with Medical Balance Protection™. Two weeks later, they had a healthy baby girl.
About a week after that, he called me. He told me putting Medical Balance Protection™ in place was the best decision he made all year. It covered the entire delivery room bill. Had his wife stayed on the school district's coverage through the delivery, he told me they would have paid out thousands of dollars instead, money that would have come straight out of a small business owner's pocket at the exact moment he had a new baby at home.
Medical Balance Protection™ protects the employee's portion of the maximum out of pocket, paying one hundred percent of hospital, cancer, and pregnancy related costs and fifty percent of lab and imaging costs. That is exactly the kind of claim it is built for, a hospital stay or a delivery, so the family is not left absorbing that covered portion.
What makes this one stick with me is the timing. This was not a plan that had been in place for years, proven out over several renewals, with every detail tested by experience and every edge case already worked through. It was two weeks old when it was asked to do the one thing it exists to do, for the one family depending on it to do it, and it did it.
I am not going to tell you every family in this situation should make the same call this family did. Every group is different, and so is every family's situation inside it. What I can tell you is that for this family, the decision to move onto a level funded plan with Medical Balance Protection™, even that close to a delivery date, turned out to be the difference between a few thousand dollars out of pocket and a fully covered delivery room bill.