Insurance Question (Kinda Long)

Mrs. jk3a · October 2009

I am mostly a lurker but I have a question. I know that you guys might not be able to help but here goes. My husband and I were planning on ttc in Jan '10. I am currently on an individual insurance plan that does not have maternity coverage.So I am going to get on my work insurance in April '10.

Our original plan was to go off the pill in Jan and start trying. Thinking that if we did get pregnant right away, we wouldn't even know until like march and then could make the 1st appointment for after April 1st. But now I am getting nervous that it would be considered a pre existing condition.

Does anyone have any experience with this or know someone that has? Would you just wait until after April to start trying? Giving your body a chance to get back to "normal" after being on the pill, and be safe that the pregnancy could not be considered a pre existing condition.

TIA!

kilissa · October 2009

I would call your insurance company and tell them the situation.

JennyV0418 · October 2009

My best friend got KU the month after she stopped BC... so it may be a risk.

locash · October 2009

Considering pregnancy as a preexisting condition is now illegal, if I'm not mistaken.

However, be careful with this. Some policies won't let you enroll mid-year (usually have an open enrollment period* at the end of each year). There are some exceptions to allow you to enroll mid-year (change of coverage status, getting married, having a baby, etc), so I'm not sure if just dropping your previous coverage b/c of what it covers is considered an accepted change of status.

ETA - used wrong word

RileyGrace · October 2009

You should definitely check, but yes, it's usually considered pre-existing and they won't cover you.

STL34 · October 2009

kilissa:
I would call your insurance company and tell them the situation.

This. Different insurance companies consider preexisting conditions differently. Additionally, many insurance plans require a waiting period before the coverage actually kicks-in.

future_mrs.lambdin · October 2009

You would be surprised how many insurance companies will not accept you b/c you are pregnant. Even if you didn't find out till after they accept you, if the first day of your last period occurred before you got on the insurance they may not cover the pregnancy. I have heard this happen many times. If you know what insurance company your work uses, I would give them a call and ask or speak with the benefits person to find out for sure. But one of them should be able to tell you how that situation would be handled.

locash · October 2009

RileyGrace:
You should definitely check, but yes, it's usually considered pre-existing and they won't cover you.

I thought this was now illegal? Perhaps it's a state by state law, not national??

Mrs. jk3a · October 2009

I can't call the insurance company because I don't know what insurance company we will have. My office manager will start looking at different insurance companies in Jan. Our open enrollment is in April. I work for a small pediatric dental office so they usually switch companies every year to get the best deal.

ams8099 · October 2009

Bad bad bad idea. Your employers insurance will not cover your pregnancy if it is a pre-existing condition. The doctor will date your pregnancy so the insurance will know.

Insurance companies do not have to cover pre-existing conditions going from an individual plan to a group plan. However they do have to cover it going from a group to group plan.

I would highly recommend waiting until April to TTC OR switch plans sooner.

Mrs. jk3a · October 2009

Thanks for the replies!

STL34 · October 2009

locash:

Considering pregnancy as a preexisting condition is now illegal, if I'm not mistaken.

However, be careful with this. Some policies won't let you enroll mid-year (usually have an open enrollment period* at the end of each year). There are some exceptions to allow you to enroll mid-year (change of coverage status, getting married, having a baby, etc), so I'm not sure if just dropping your previous coverage b/c of what it covers is considered an accepted change of status.

ETA - used wrong word

I think that law only applies if you are changing from one group health care plan to another and thus switching from individual coverage to a group plan could result in a pregnancy being considered a pre-existing condition.

RileyGrace · October 2009

locash:

Considering pregnancy as a preexisting condition is now illegal, if I'm not mistaken.

However, be careful with this. Some policies won't let you enroll mid-year (usually have an open enrollment period* at the end of each year). There are some exceptions to allow you to enroll mid-year (change of coverage status, getting married, having a baby, etc), so I'm not sure if just dropping your previous coverage b/c of what it covers is considered an accepted change of status.

ETA - used wrong word

Nope, it depends on your state law.

locash · October 2009

ams8099:

Bad bad bad idea. Your employers insurance will not cover your pregnancy if it is a pre-existing condition. The doctor will date your pregnancy so the insurance will know.

Insurance companies do not have to cover pre-existing conditions going from an individual plan to a group plan. However they do have to cover it going from a group to group plan.

I would highly recommend waiting until April to TTC OR switch plans sooner.

Your explanation makes sense and I was wondering the same thing about the switch (since it was b/c of lack of coverage). That kind of clears up my question about pre-existing condition. So, if she were to move from her company insurance to her husband's company insurance after getting ku, for example, she would be covered?

Just trying to understand!

ams8099 · October 2009

locash:
ams8099:

Bad bad bad idea. Your employers insurance will not cover your pregnancy if it is a pre-existing condition. The doctor will date your pregnancy so the insurance will know.

Insurance companies do not have to cover pre-existing conditions going from an individual plan to a group plan. However they do have to cover it going from a group to group plan.

I would highly recommend waiting until April to TTC OR switch plans sooner.

Your explanation makes sense and I was wondering the same thing about the switch (since it was b/c of lack of coverage). That kind of clears up my question about pre-existing condition. So, if she were to move from her company insurance to her husband's company insurance after getting ku, for example, she would be covered?

Just trying to understand!

From what I understand, yes. As long as there is no lapse in coverage.

Mrs. jk3a · October 2009

So do you think it would be ok to go off the pill and use condoms ( I know it not 100% but neither is bc pills) and then actively start trying in April?

locash · October 2009

ams8099:
locash:
ams8099:

Bad bad bad idea. Your employers insurance will not cover your pregnancy if it is a pre-existing condition. The doctor will date your pregnancy so the insurance will know.

Insurance companies do not have to cover pre-existing conditions going from an individual plan to a group plan. However they do have to cover it going from a group to group plan.

I would highly recommend waiting until April to TTC OR switch plans sooner.

Your explanation makes sense and I was wondering the same thing about the switch (since it was b/c of lack of coverage). That kind of clears up my question about pre-existing condition. So, if she were to move from her company insurance to her husband's company insurance after getting ku, for example, she would be covered?

Just trying to understand!

From what I understand, yes. As long as there is no lapse in coverage.

Ah, that makes sense to me now. Thanks for answering my 38473 questions on this!

And OP - my honest recommendation is to go on your company's plan ASAP, that way you don't really have to worry about it. If you can't get on until April, then condoms should be your best bet.

PinkLove-S · October 2009

I don't know about health insurance but for Short term disability, you CANNOT be pregnant when you start the coverage but could soon after. You need to have 10 months of coverage before you use it, at least that is how my insurance offered (AFLAC) is... You need to call and check though so you can plan accordingly! Good luck!

ams8099 · October 2009

Mrs. jk3a:
So do you think it would be ok to go off the pill and use condoms ( I know it not 100% but neither is bc pills) and then actively start trying in April?

Sure, that would be semi-safe. You could start charting in that time as well.

court1703 · October 2009

locash:

RileyGrace:
You should definitely check, but yes, it's usually considered pre-existing and they won't cover you.

I thought this was now illegal? Perhaps it's a state by state law, not national??

I thought it was illegal too

Marielle0430 · October 2009

Mrs. jk3a:

Our original plan was to go off the pill in Jan and start trying. Thinking that if we did get pregnant right away, we wouldn't even know until like march and then could make the 1st appointment for after April 1st.

Can I just be annoying for a second and recommend that you try to at least attempt to test early enough so that you are not going to your first prenatal appointment late in your first trimester or into your second trimester? Sorry but this is what i do everyday at work...try to get women into prenatal care as early as possible. Just my 2 cents!

Good luck!!

DaniLovesPink · October 2009

I've always been under the impression that pregnancy would be covered as long as there was not a lapse in maternity coverage. But, considering your current plan does not offer maternity coverage, it might not work. I would just call.

locash · October 2009

Ok, sorry to keep pushing this, but I found this explanation (here is the source https://www.cms.hhs.gov/HealthInsReformforConsume/Downloads/protect.pdf):

Under HIPAA?s group market rules, there can be no pre-existing condition exclusion for pregnancy, no matter when pregnancy began and whether medical advice, diagnosis, care or treatment was recommended or received for the pregnancy. An exclusion cannot be applied to you even if your previous health plan did not cover pregnancy.

Mrs. jk3a · October 2009

Marielle0430:
Mrs. jk3a:

Our original plan was to go off the pill in Jan and start trying. Thinking that if we did get pregnant right away, we wouldn't even know until like march and then could make the 1st appointment for after April 1st.

Can I just be annoying for a second and recommend that you try to at least attempt to test early enough so that you are not going to your first prenatal appointment late in your first trimester or into your second trimester? Sorry but this is what i do everyday at work...try to get women into prenatal care as early as possible. Just my 2 cents!

Good luck!!

You are not being annoying, I understand what you mean. I would definitely go to the doctor as soon as they could get me in, whether I was covered or not. I know that is not the way it sounded.

Mrs. jk3a · October 2009

locash:
Ok, sorry to keep pushing this, but I found this explanation (here is the source https://www.cms.hhs.gov/HealthInsReformforConsume/Downloads/protect.pdf):
Under HIPAA?s group market rules, there can be no pre-existing condition exclusion for pregnancy, no matter when pregnancy began and whether medical advice, diagnosis, care or treatment was recommended or received for the pregnancy. An exclusion cannot be applied to you even if your previous health plan did not cover pregnancy.

A girl that I currently work with got pregnant in April did not have insurance and was going through a divorce. She got on the insurance at work and they are covering her pregnancy. They covered her even though she was pregnant well before she got coverage.

locash · October 2009

Mrs. jk3a:
locash:

Ok, sorry to keep pushing this, but I found this explanation (here is the source https://www.cms.hhs.gov/HealthInsReformforConsume/Downloads/protect.pdf):

Under HIPAA?s group market rules, there can be no pre-existing condition exclusion for pregnancy, no matter when pregnancy began and whether medical advice, diagnosis, care or treatment was recommended or received for the pregnancy. An exclusion cannot be applied to you even if your previous health plan did not cover pregnancy.

A girl that I currently work with got pregnant in April did not have insurance and was going through a divorce. She got on the insurance at work and they are covering her pregnancy. They covered her even though she was pregnant well before she got coverage.

Yes, that was my understanding of things. I think if you were switching between independent plans, this law would do nothing to protect you. As long as you are switching to a group plan, you should be covered for any treatment after your coverage begins. Still try to call to verify when you can, though. GL!

Mrs. jk3a · October 2009

Thanks for all the help ladies! We will just other protection until I find out what insurance company we are using. Then I will call and talk to them and see if they consider it a pre existing condition.

Good luck to all you ladies too! And Congratulations to those who are already pregnant!

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Insurance Question (Kinda Long)

Re: Insurance Question (Kinda Long)

FET to TTC #2: 9/29/14 Beta on 10/8/14 = BFP!

DS #1 Born 1/3/11 after IVF #1

4 failed IUIs, including 1 CP

PCOS

TTC since 2008

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