Expecting a new baby and wondering about policy plan options

My wife and I have been on my employer’s high deductible HSA plan for the past few years and it has served us well. At this point, I’ve amassed a nice little pile of triple-tax advantaged funds, which I think of as “savings for future medical needs” (I make the maximum contribution and try to pay any costs we do incur from our savings in order to grow the HSA). This is fine, but we have become pregnant (due in early-mid April ’21) and as it’s our first child and we’re super anxious about making sure she’ll be taken care of in any way that she might need, I’m expecting to need to beef up my coverage. This all leads me to 2 major questions; I really appreciate any advice or clarity you all might have to offer!

  1. Since I know we are going to have, at the very least, a lot of medical visits/bills leading up to her birth, and then of course, the hospital bill for the delivery itself, there’s no question in my mind that I would be meeting my deductible fairly early in the year. My (limited) understanding of how these things are supposed work makes me think that since I know I’m going to have a bunch of expenses I should probably choose a higher premium/lower deductible plan. However, when I do some math, I’m not so sure, after all!

Annual premiums cost:

PPO EPO EPO (limited network) HSA (limited network)
Employee +1 $9,785 $6,625 $4,621 $4,514
Family $18,136 $11,710 $8,730 $6,970

As I mentioned above, I’m currently on Employee +1 HSA plan. The deductible is $4,000 (w/a $6,000 out-of-pocket max), and is the same for the family plan. My employer contributes $3,000 for my participation.

So, am I wrong in thinking that, effectively, not including co-pays, my potential cost for the year is relly only just $1,000 more than the annual premiums ($4,000 deductible – $3,000 from my employer)? And then I’m 100% covered for the remainder of the policy year? So if we’re talking about the family plan, unless I had specific provider requirements out-of-network, why would I choose anything other than the HSA? I’ve been under the impression that if I know I will be utilizing my insurance at a higher level, then an HSA is probably not for me as compared to an EPO, but if I know I’m starting the year off meeting the deductible and the rest of the year will be 100% paid for, then it doesn’t look to me like I save money by choosing something other than the HSA. This is confusing…

2) I know that the birth of my child will be a qualifying event, and at that point I’ll need to switch over from “Employee +1” to “Family” plan coverage. How does that work? When my child is born, if, god-forbid, she needs to go to the NICU or receive special care, how does that get billed — is it just through our coverage or does she need to then be retroactively covered and billed afterward or something? That, and if I change from HSA Employee +1 to HSA Family coverage, is the deductible reset? That is, we will clearly meet the deductible upon giving birth, if not before then, so will that carry over when new baby girl is added to the policy, or does the deductible clock start again at $0?

This is confusing enough already without knowing this is all coming in a few months… any and all help is greatly appreciated!

Edited to add: I’m in NY State

submitted by /u/BearInCognito
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My wife and I have been on my employer’s high deductible HSA plan for the past few years and it has served us well. At this point, I’ve amassed a nice little pile of triple-tax advantaged funds, which I think of as “savings for future medical needs” (I make the maximum contribution and try to pay any costs we do incur from our savings in order to grow the HSA). This is fine, but we have become pregnant (due in early-mid April ’21) and as it’s our first child and we’re super anxious about making sure she’ll be taken care of in any way that she might need, I’m expecting to need to beef up my coverage. This all leads me to 2 major questions; I really appreciate any advice or clarity you all might have to offer! ​
Since I know we are going to have, at the very least, a lot of medical visits/bills leading up to her birth, and then of course, the hospital bill for the delivery itself, there’s no question in my mind that I would be meeting my deductible fairly early in the year. My (limited) understanding of how these things are supposed work makes me think that since I know I’m going to have a bunch of expenses I should probably choose a higher premium/lower deductible plan. However, when I do some math, I’m not so sure, after all!
Annual premiums cost:

PPO EPO EPO (limited network) HSA (limited network)

Employee +1 $9,785 $6,625 $4,621 $4,514

Family $18,136 $11,710 $8,730 $6,970

As I mentioned above, I’m currently on Employee +1 HSA plan. The deductible is $4,000 (w/a $6,000 out-of-pocket max), and is the same for the family plan. My employer contributes $3,000 for my participation. So, am I wrong in thinking that, effectively, not including co-pays, my potential cost for the year is relly only just $1,000 more than the annual premiums ($4,000 deductible – $3,000 from my employer)? And then I’m 100% covered for the remainder of the policy year? So if we’re talking about the family plan, unless I had specific provider requirements out-of-network, why would I choose anything other than the HSA? I’ve been under the impression that if I know I will be utilizing my insurance at a higher level, then an HSA is probably not for me as compared to an EPO, but if I know I’m starting the year off meeting the deductible and the rest of the year will be 100% paid for, then it doesn’t look to me like I save money by choosing something other than the HSA. This is confusing… ​ 2) I know that the birth of my child will be a qualifying event, and at that point I’ll need to switch over from “Employee +1” to “Family” plan coverage. How does that work? When my child is born, if, god-forbid, she needs to go to the NICU or receive special care, how does that get billed — is it just through our coverage or does she need to then be retroactively covered and billed afterward or something? That, and if I change from HSA Employee +1 to HSA Family coverage, is the deductible reset? That is, we will clearly meet the deductible upon giving birth, if not before then, so will that carry over when new baby girl is added to the policy, or does the deductible clock start again at $0? This is confusing enough already without knowing this is all coming in a few months… any and all help is greatly appreciated! ​ Edited to add: I’m in NY State
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