Health plans aren't preparing employers for the 2027 maternity fee unbundling change. We are.
Reproductive & Maternal Health (RMH) Compass recently hosted a virtual session with clients on a change coming January 1, 2027: maternity fee unbundling. What became clear in the conversation is that employers are largely on their own right now when it comes to preparing for it.
Here's what we heard, why the guidance gap matters, and how employers can start closing it.
The maternity fee unbundling change, briefly:
Starting January 1, 2027, maternity care fees shift from a single bundled payment to itemized, unbundled billing. Each individual service – from prenatal visits, labs and screenings to postpartum care – will be coded and billed separately.
That shift changes how and when cost-sharing applies, with direct implications for patients' out-of-pocket costs and for employer health care spend.
What we heard from employers about this change:
Brokers and health plans don’t have the information they need yet. As we expected, clients told us their brokers and health plans haven't raised this change or explained what it means for their organization. This tracks with the broader landscape, where very few experts have what they need to discuss the implications for employers and workers.
There's real confusion about what benefits employees have access to. HR leaders weren’t confident that they knew which maternity benefits are actually covered under their health plans. Things like midwifery coverage, maternity care coordination services, and doula reimbursement are often buried in health plan jargon or undocumented altogether, making it hard for employees to know that low-cost provider coverage and other important benefits exist.
A deeper concern: rising maternity complexity. Beyond benefits confusion, there’s a growing concern that cuts closer to patient outcomes. If out-of-pocket costs rise under unbundling, patients may delay or skip critical prenatal care to save money, raising the likelihood of pregnancy complications, preterm births, and NICU admissions – all of which will significantly drive up health care costs and can put employees and their babies at greater risk.
Why the guidance gap matters:
Taken together, these gaps point to real risk while employers wait for guidance that isn't coming from the usual channels.
Employees could absorb costs they don't need to. If workers don't know which low-cost providers are covered, they may default to higher-cost care and pay more out-of-pocket than their plan requires, simply out of not knowing better.
Existing benefits go unused. When employers themselves aren't confident in what maternity-related benefits their plan already includes, they can't communicate that coverage to employees. Benefits that are already being paid for sit unused, delivering no value to the workforce or return on the employer's investment.
Cost trends become harder to explain. As billing becomes more granular, utilization patterns that were previously masked inside a bundled rate will surface on their own. Employers without a clear picture of their current benefits will be less equipped to interpret spend increases or push back on them.
Health plans won't necessarily fill the gap. With few outside experts covering this change, employers waiting for their health plan to give them guidance will miss key opportunities to improve care and reduce out-of-pocket costs for their employees and their dependents.
Where employers can start:
The absence of outside guidance doesn't mean employers have to figure this out from scratch. Three steps can help close the gap before January 2027.
Audit current maternity benefits. Confirm exactly what's already included in the health plan, including low-cost providers, care navigation services, and mental health support.
Communicate proactively with employees. Many workers don't know the full scope of maternity benefits they already have access to. Early communication can help minimize confusion and unexpected costs once unbundling takes effect.
Bring it up in broker negotiations. Ask brokers directly how the plan will handle unbundled maternity billing, and push for benefit designs that protect workers from unnecessary cost-sharing.
The takeaway:
Brokers, health plans, and most industry experts haven't caught up to this change yet. That's exactly where RMH Compass can help. We're working directly with HR and benefits leaders to close the knowledge gap, both internally and for their employees, so they're prepared well ahead of January 2027.
Learn more:
We're hosting more virtual gatherings to share our guidance on how employers can prepare for this change. Join us on Wednesday, July 22 at 1:00 PM ET or Tuesday, August 13 at 2:00 PM ET to learn more.
Wednesday, July 22, 1:00–1:45 PM ET
Register here
Thursday, August 13, 2-2:45 PM ET
Register here
