Insurance is one of the larger and more variable line items in a surrogacy budget, and it's driven by the surrogate's specific policy far more than by either party's home state. This page is the checklist — the state-by-state pages link here instead of repeating it 51 times.
Confirm the surrogate's coverage before matching, not after
Before finalizing a match, get a written determination from the surrogate's current health plan on whether it excludes a pregnancy. This should happen during screening, not after the is signed — an excluded pregnancy changes the budget substantially.
Budget for a dedicated surrogacy policy as the likely outcome
Many surrogates' existing plans exclude compensated or surrogacy pregnancies, so intended parents should plan for the cost of a dedicated surrogacy insurance policy rather than treating it as an edge case. This cost is typically funded through the account alongside and the surrogate's own compensation — ask the agency or escrow company for a full breakdown of what the insurance line item covers (premiums, deductible, co-insurance, a complications rider) before funding escrow.
Complications coverage is a separate question from base coverage
A policy that covers a routine delivery may cap or exclude coverage for complications like a NICU stay, an extended hospital admission, or a C-section. Ask specifically about complications coverage and lifetime/per-incident caps — this is where unplanned costs are most likely to show up after the fact.
Newborn coverage is a separate policy from the surrogate's
The surrogate's insurance covers her pregnancy and delivery. It does not cover the baby after birth. Intended parents need their own health insurance in place for the newborn, and should confirm how quickly their plan (employer or marketplace) allows enrollment after a birth via surrogacy — this sometimes requires proof of the parentage order, so coordinate the timing with the attorney handling that paperwork.
If the intended parents are covering fertility treatment costs
IVF, embryo transfer, and related fertility treatment costs are typically billed to the intended parents directly (or through the clinic), separately from the surrogate's pregnancy and delivery insurance. Some states require certain insurers to cover infertility treatment for the intended parent — that's a state-specific question worth raising with the fertility clinic's billing office, distinct from the surrogate's pregnancy coverage covered on this page.
This isn't insurance or legal advice
Every policy is different, and small details in the plan document can change the answer. Confirm directly with the carrier, the escrow company, and the professionals handling the arrangement before relying on anything here.