Another health care coverage question

BlessedMommy723

Does anyone know if OH considers pregnancy a pre-existing condition, or does it depend on which ins company you are going to use?

DH and I are relocating to OH and I am currently covered on his insurance. He will be leaving his job and I will be working instead (woo-hoo just got hired in a school!!!).

Where could I find this information? We are trying to see if we need DH to stay and work a couple of weeks after DD and I move so that we can have continuous coverage for me, or if two weeks of no coverage will be OK. TIA!!

dejavu22

I don't think it matters what state you are in, just what type of insurance you have.  From the research I had done about it (I just got new coverage at work) it is NOT a pre-existing condition & must be covered.  Best case scenario, just check with your job as to what company your insurance will be through & call them directly.

kldunlea

Per HIPAA pregnancy is not a pre-existing condition.  However, there are loopholes in HIPAA.  If your husband will be covered by an HMO it may be considered a pre-existing condition.  If the coverage is a PPO or a POS you would be in better shape. Would you be able to find out about the coverage ahead of time and who the carrier is?  Then you can call the carrier and ask the question.  That is what we did with my husband's plan...he is a teacher...and I wanted to be added to his coverage for dual coverage since my insurance went down the pooper this year. 

 

BlessedMommy723

I actually have a call in to the principal who offered me the job this morning. I'm just waiting on her to call back with the insurance information Thanks ladies for your help. I think we will probably have DH stay and work until mine kicks in so there are NO issues. He would have to give a month notice, but he has 2 weeks worth of vacation already scheduled, so he's really only working two weeks away from us

aldyn

BlessedMommy723:

I actually have a call in to the principal who offered me the job this morning. I'm just waiting on her to call back with the insurance information Thanks ladies for your help. I think we will probably have DH stay and work until mine kicks in so there are NO issues. He would have to give a month notice, but he has 2 weeks worth of vacation already scheduled, so he's really only working two weeks away from us

It does matter which state you're in as the state will force the hand of the insurance company if they have laws about whether or not pregnancy can be excluded as a pre-existing condition.

If the principal doesn't know, perhaps she can give you the name of someone that works in HR for the district that will be able to help you with your coverage questions.  This is pretty important to find out NOW before you make any changes.

nomadicprincess

According to Federal Law, as long as you have been covered by insurance at least 6 months prior to getting your new insurance, you should be covered for ALL pre-existing conditions.  Therefore, it doesn't matter.  You just need to present a certificate of prior coverage from your last insurance. 

kldunlea

Not necessarily true.  The carrier has to be contacted:

the laws that govern group and individual health plans are a little different when it comes to pre-existing conditions, and are enforced or regulated by the state department of insurance in the state where you live.

I work in benefits with many carriers.  Where the above comes into play is with HMOs who are more likely to follow state law, which does not always match federal law. 

Federal law is more aligned with PPO and POS plans.

nomadicprincess

kldunlea:

Not necessarily true.  The carrier has to be contacted:

the laws that govern group and individual health plans are a little different when it comes to pre-existing conditions, and are enforced or regulated by the state department of insurance in the state where you live.

I work in benefits with many carriers.  Where the above comes into play is with HMOs who are more likely to follow state law, which does not always match federal law. 

Federal law is more aligned with PPO and POS plans.

I've had several HMOs over the years, in different states, and they were always covered as long as I had a certificate of coverage.  The law was changed under Clinton.  As long as you have "continuous coverage" with no more than a 63 day break in insurance (sorry, thought it was 6 months--that is for something else), all pre-existing conditions should be covered

The following is from the Dept of Labor website:

"I began working for a new employer 45 days after my prior group health plan was terminated. I had continuous coverage in my former employer's plan for 24 months with no other coverage between jobs. Can I be subject to a preexisting condition exclusion period?
No, not if you enroll when you are first eligible. Those 45 days do not count as a significant break in coverage. Also, since you have more than 12 months of continuous coverage in a prior health plan, it can be used to fully offset and eliminate the maximum preexisting condition exclusion period under a new plan."

Look at below for more info, but the way I understand it...pregnancy can not be counted as a pre-existing condition according to federal law. 

https://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html

nomadicprincess

One more thing...state law can only "improve" federal law on insurance issues.  It can not restrict things more.

kldunlea

I will agree to disagree.  I agree with you both partially, but not fully.

Final comment:

https://www.politifact.com/truth-o-meter/article/2009/aug/18/pregnancy-pre-existing-condition/

Hope everyone has a lovely evening.

nomadicprincess

kldunlea:

I will agree to disagree.  I agree with you both partially, but not fully.

Final comment:

https://www.politifact.com/truth-o-meter/article/2009/aug/18/pregnancy-pre-existing-condition/

Hope everyone has a lovely evening.

LOL!  In that link I gave, HIPAA specifically says that pregnancy is NOT  a pre-existing condition.  If a company's insurance goes against that, they are breaking federal law and can be reported.