Even though federal law prevents pregnancy from being considered as a pre-existing condition, pregnant women can still find themselves without insurance coverage for prenatal care and the baby’s delivery. Since individual insurance companies have their own guidelines for coverage, a pre-existing pregnancy can be a complicated insurance issue.
The Health Insurance Portability and Accountability Act (HIPAA) prevents health insurers from terming pregnancy as a pre-existing condition in the event that the insured changes jobs or health plans when already pregnant. In this case, the insurer cannot deny coverage as long as the plan includes maternity coverage.
Group Health Plans
While HIPAA offers the most protection, it does not apply to everyone who needs coverage. HIPAA does not cover an individual who previously had no health insurance coverage or was covered under an individual plan and is then accepted in a group health plan. Even if a woman is enrolled in a new health insurance, the plan does not have to immediately cover her pregnancy. In other cases, a plan may require a pre-existing waiting period that can run longer than the pregnancy.
When changing from one individual health insurance plan to another, pregnancy often is not covered. Even if a private plan covers pregnancy, the coverage could be expensive. Many insurance companies also require a waiting period. If you change jobs, but are not eligible for new group coverage until the eligibility period expires, your former employer is legally obligated to offer you a COBRA plan. This is one way to remain insured until your new plan becomes effective. However, many women cannot afford to pay the premiums, which can be more than 100 percent of the premium cost with administrative fees added. If your previous employer had fewer than 20 employees, the company is not required to offer you COBRA coverage.
Some individual and group health plans have a one-month probationary period before you are eligible for insurance. While your pregnancy may be covered under an employer-sponsored plan, that coverage will not take effect until the plan takes effect. This could present problems if you are in the later months of pregnancy and find yourself without coverage for 30 days.
Short-Term Medical Plan
Because a short-term or temporary health insurance plan is intended to provide medical coverage for people who find themselves without health insurance for a brief time, a pregnancy makes a woman ineligible for coverage. Since the purpose of a short-term plan is to fill a temporary need, an entire family can be denied coverage when one family member is pregnant.
Short-Term Disability Plan
In most cases, short-term disability plans will not cover the medical costs associated with pregnancy until after you have been covered by the plan for at least one year. Although some short-term disability plans provide medical coverage for up to 12 months, many policies exclude pregnancy on the grounds that it is a pre-existing condition. Few plans will accept an applicant who has any kind of pre-existing condition. At the very least, plans typically have an exclusionary period under which a pre-existing condition is not covered until the period ends. The timing may not coincide with a pregnancy.
A pre-existing condition is typically defined as any health condition for which a person received medical care three to six months before the effective date of the policy. According to the American Pregnancy Association, it is estimated that about 13 percent of women who become pregnant in the U.S. each year are not covered by health insurance. So if you are thinking about getting pregnant, it might be wise to confirm the terms of your health insurance plan before your intentions become a reality. But if you are already pregnant and changing jobs, or if your spouse is thinking about changing jobs, bear in mind that you could find yourself without medical coverage for a time and plan accordingly.