A hypothetical Question

JennaNAaron · July 2010

and at this point it is still hypothetical

Is pregnancy considered a pre-existing condition for insurance? Right now we are in between insurance because DH left his old job at the end of June and his new insurance will kick in September 6th. I'm wondering *if* I were to become pregnant and just not go to the doctor before then if it would still be a pre exisiting. I don't know how that works with pregnancy and insurance. Not saying I'm pregnant...just having some suspicions

BackthePack · July 2010

I'm not sure, but to be safe I wouldn't go to the dr until after your insurance kicked in. When I signed up for Short Term Disability (while TTC #1), the insurance agent told me if I happened to get pregnant before it kicked in (about a month or so), then don't go to the doctor because it would have been considered pre-existing.

lalabee0425 · July 2010

I can't swear to it, but I'm pretty sure it is considered a pre-existing cond. Good luck! Hope the timing works out for you guys!

JennaNAaron · July 2010

I definitely wouldn't go until after the insurance kicked in. We already signed up for it...and I think my insurance goes into effect next month...hmmmm idk.

megm4705 · July 2010

Is it group or private insurance? If it is group they cannot deny coverage for pre-existing. Private they can. We had to do a lot of research last year when DH got a new job while I was pregnant.

JennaNAaron · July 2010

It'll be group...we both have BCBS PPO. I'm probably worried about it for no reason....

Mrs.LLG · July 2010

Its not considered pre existing if there is no lapse in coverage. So your best bet would be either A) don't go to a doctor or

take cobra coverage for the time between so there would be no lapse.

MrsSavannah · July 2010

It is not considered pre-existing if your lapse in coverage is no more than 63 days. I went through this and I went to the dr when I first got my BFP, went when I had no coverage and paid for that 1st appointment and ultrasound out of pocket, then once I had coverage again I went back and had all the expensive bloodwork done. Here is some info I have on it:

Below are two sources including a governement website describing the 63 Day Grace Period.

Source-1: https://www.healthcare.com/health-insurance/guides/helpful-tips/avoiding-lapses-in-health-insurance-coverage/

If you are in between jobs and previously had employer-based health insurance, it is critical that you avoid a prolonged lapse in medical coverage. Health insurance companies try to control costs by invoking "pre-existing condition" clauses, refusing to cover treatments for a medical condition they say you had before you purchased the health insurance policy. The Health Insurance Portability and Accountability Act, HIPAA, protects you from having conditions that were covered by your current health insurance plan being ruled ?pre-existing? when you move form one job, and therefore one health insurance plan to another. However, the HIPAA protections only apply if there has not been a significant lapse in coverage. Under the law, you only have about two months for protection under HIPAA before a future health insurer can turn you down for a new policy based on a pre-existing condition. Under the federal HIPAA regulations if you have had health insurance for more than 18 months an insurance company cannot place a waiting period on pre-existing medical conditions if you haven?t been without medical coverage for over 63 days.

While you can maintain your health insurance under the COBRA provisions, COBRA is generally an expensive option. Most high-deductible health insurance plans, which have lower relative monthly premium costs, will meet the HIPAA requirements for ?continuous coverage?. Some short-term health insurance policies may also keep you HIPAA eligible, but it is the exception rather than the rule for short-term plans because of their limited scope of coverage. It is best to check with a qualified health insurance professional before you assume that a short-term health insurance policy qualifies as ?continuous coverage? under HIPAA.

Source-2: https://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html

Is there a limit to the period of time I can go without coverage between jobs if I want to reduce the length of a preexisting condition exclusion?
Yes. The break in coverage between one period of health coverage and another can be no longer than 63 days (just over 2 months). If you are between jobs and do not have health coverage for 63 days or more, then you may lose the ability to use the coverage you had before the break to offset a preexisting condition exclusion period in a new health plan.

MrsSavannah · July 2010

I opted not to get COBRA because it was way more expensive than the two sick visits I had to take Savannah to and my first appointment and ultrasound. However, had we had anything uexpected happen that was really expensive, you can get it retroactively.

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