Surrogacy Insurance in California: Navigating ACA Changes and Coverage Options

At ACRC Global, we understand that navigating insurance options and open enrollment can feel overwhelming, confusing, or even a little intimidating. That’s why we’re here to walk alongside intended parents and surrogates every step of the way; providing guidance, sharing insights, and offering support to help you make informed decisions with confidence.

Drawing from our experience managing surrogacy cases in California, and from the expertise of trusted insurance professionals, we aim to make this process as clear, manageable, and empowering as possible.

Anthem Coverage: What Families Need to Know Now

For many years, Anthem was one of the most commonly used policies for surrogates in California. A major reason? Anthem policies were available without a lien.

In surrogacy, a lien refers to a financial claim the insurance company can place on the surrogate’s earnings (a portion of her base compensation based on the signed surrogacy agreement).

The final lien amount isn’t fixed until after care is completed, but industry data and case trends in California show that liens typically range from one-third (33%) up to the full amount (100%) of the surrogate’s compensation.

Here’s how it often plays out in practice:

• If a surrogate is compensated $50,000, an insurer might claim up to $16,667, if the lien is capped at one-third.

• In other cases, particularly with carriers that don’t cap liens, they could potentially claim the entire $50,000, depending on medical costs and policy terms.

Because Anthem typically did not carry these repayment obligations, it was often considered one of the most straightforward and predictable options for intended parents.

However, recent data shows the situation has been shifting. In recent years, many OBs (obstetricians) in California have stopped accepting Anthem for surrogates. This change has created some real challenges:

• Challenges in Accessing Prenatal Care: As more OBs stop accepting Anthem, surrogates are facing a growing scarcity of available providers. This often means longer wait times, limited appointment slots, and offices booked months in advance. As a result, some surrogates may experience delays in starting prenatal care or may miss critical first-trimester screenings such as NT scans or NIPT bloodwork. These early tests are time-sensitive and play an important role in monitoring the pregnancy, making timely access to care essential.

• OB Acceptance Can Change Mid-Pregnancy: OB offices are not required to follow open enrollment timelines and can stop accepting Anthem at any point. Even if a surrogate is already under care, the provider may discontinue coverage, requiring the surrogate to find a new OB. Depending on how far along she is, securing an alternative provider willing to accept Anthem can be especially challenging.

While every surrogacy journey is unique, these trends have become increasingly common. For this reason, many families are exploring alternative coverage options to help ensure their surrogate can access timely, uninterrupted care.

Exploring Coverage Options

At ACRC Global, we aim to help families navigate surrogacy insurance by connecting them with trusted professionals and sharing insights from the many journeys we’ve managed.

Based on what we’ve observed, two alternatives to Anthem have become increasingly common in California: Lloyd’s of London surrogacy plans and ACA policies with a lien.

💬 Feeling unsure about which insurance path is right for your surrogacy journey? At ACRC Surrogacy, we’ve guided hundreds of Intended Parents and Surrogates through these exact decisions. Our team partners with trusted insurance professionals to simplify the process, answer your questions, and help you avoid costly mistakes.

👉 Schedule a Free Consultation Today and take the first step toward clarity and confidence in your coverage.

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Lloyd’s of London Surrogacy Plans

Lloyd’s of London is a specialized insurance market made up of underwriters who pool resources to cover unique situations—like surrogacy—that traditional insurers may not fully address. These plans are designed to provide comprehensive coverage for surrogates, including prenatal care, delivery, and pregnancy complications, while often being lien-free.

How Lloyd’s Coverage Typically Works:

1. Maternity Cost Estimate:

   1. The surrogate’s prenatal and delivery plan is reviewed, and a cost estimate is prepared.

   2. Medical billing teams often negotiate rates directly with providers.

2. Underwriting:

   1. The surrogate’s medical records are evaluated against Lloyd’s “Preferred Criteria.”

   2. A deductible is set, typically around $19,000 or higher, based on the estimate and pregnancy risk factors.

3. Confirmation of Pregnancy:

   1. A payment is collected to cover underwriting, medical billing management, and coverage for severe complications (up to $500,000).

   2. This activates the policy and ensures financial protection throughout the pregnancy.

Coverage Highlights

• Routine prenatal visits, lab work, ultrasounds, and first-trimester screenings like NT and NIPT

• Delivery, hospital care, anesthesia, and postpartum care

• Bed rest or physician-ordered hospitalization (sublimit ~$50,000)

• Use of approved providers to ensure coverage

Estimated Costs:

• Uncomplicated pregnancy: typically between $20,000–$27,500

• Any excess from the cost estimate is returned

*Please note: Higher costs may apply for twins, high-cost providers, or surrogates outside preferred criteria

Key Benefits for Intended Parents:

• Lien-Free Structure: Most plans do not require repayment after delivery, reducing financial uncertainty.

• Broad OB Acceptance: Many providers are familiar with Lloyd’s plans, making it easier to schedule timely care.

• Predictable, Transparent Costs: Clear step-by-step process with known estimates helps families plan financially.

Lloyd’s of London plans provide a flexible, reliable, and comprehensive insurance solution, making them a popular choice when traditional insurance options may be limited.

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ACA Policies with a Lien

Another option families often consider is enrolling a surrogate in an ACA plan that carries a lien. While these policies provide full maternity coverage, they come with different financial considerations.

Key observations about ACA plans with a lien:

• Comprehensive Coverage: Includes prenatal visits, lab work, screenings (NT, NIPT), hospital delivery, anesthesia, postpartum care, and management of complications.

• Lien Requirement: A lien means the insurer may request repayment for any costs they covered. Based on trends, liens typically range from $15,000–$40,000 depending on the plan and pregnancy. The final amount isn’t known until after delivery, so planning ahead is important.

• Premium Costs: Monthly premiums usually range $400–$1,000, varying by surrogate and plan.

• Planning Considerations: Families are required to establish an extension account within their existing trust to hold the anticipated lien amount. This helps streamline repayment after delivery and reduces administrative stress.

ACA policies with a lien remain a viable option, but careful planning and coordination with brokers and providers are essential to ensure timely care and financial preparedness.

Managing Lien Accounts

At ACRC Global, we help families manage lien preparation by setting up an extension account within the existing trust account, designated solely for anticipated lien funds.

• The final lien amount is determined after delivery, based on the insurer’s claims.

• Funds are securely held until the balance is finalized.

• Once determined, payments can be distributed efficiently, helping families stay organized and reduce stress.

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Surrogacy Insurance Comparison Chart

Feature	Anthem (No Lien)	Lloyd’s of London	ACA Policy with Lien
Lien Required?	❌ No	❌ Usually No	✅ Yes ($15k–$40k, ≈33–100% of comp.)
Premium /Total Cost	$7k–$15k	$20k–$27.5k	$400–$800/month
OB Acceptance	Limited	Broader	Moderate
Prenatal Care Availability	Risk of delay	Easier	Moderate

Note: Observations based on trends from ACRC Global cases and insurance professionals from previous open-enrollment years (Prior to 2025). Individual experiences and current market year prices are subject to increase and may vary.

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📩 Insurance is one of the most important pieces of the surrogacy journey. Whatever path is chosen, our team is here to provide guidance, administrative support, and reassurance; helping families focus on what truly matters: a healthy and successful surrogacy journey.

ACRC Surrogacy Celebrating its 10 Year Anniversary

Looking back on the past ten years fills our hearts with gratitude for every Intended Parent we’ve had the honor to support. Being able to gather in the headquarter and celebrate a milestone means more than the event but a reminder of the love, care, and dedication every team member of ACRC Surrogacy bring to every family’s surrogacy, egg donation, sperm donation, or IVF journey. We are grateful for your trust, and to continuing to support you in welcoming the baby home.

Schedule an Intended Parent Consultation

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References on Surrogacy Insurance

• Tsong, J. (2022, October 26). Surrogacy and open enrollment: What Intended Parents need to know. Tsong Law.

• ArtRisk Solutions. (n.d.). Surrogacy maternity insurance options for Intended Parents and Surrogates.