anyone good with insurance out there?

patientnwaiting · April 2012

I know that some individual plans can treat pregnancy as a pre existing condition and deny you coverage because of it. I was wondering that applies to spouses as well? My current insurance ends in July but I am getting married in June and FH is going to put me on his plan. I was just wondering if anyone knew if the insurance company can say no based on pregnancy being pre existing condition?

MrsFelts · April 2012

I know in WA state pregnancy is a preexisting condition. However, as long as you have had 18 months of previous coverage your new insurance company should cover maternity care. I don't think there can be any period of lapse of coverage though. Pretty much is prevents people from getting insurance as soon as they get pregnant just so maternity care is paid for.

spritz · April 2012

I did some reading, and it doesn't sound like group plans can treat pregnancy as a pre-existing condition. I will also be switching insurance plans in July, and I'm nervous about it so I've been doing a ton of reading.

MrsFelts · April 2012

spritz:
I did some reading, and it doesn't sound like group plans can treat pregnancy as a pre-existing condition. I will also be switching insurance plans in July, and I'm nervous about it so I've been doing a ton of reading.

I think it really depends on the state, because I did a lot of research last year when I was pregnant. I was told by every insurance company I called in WA state that pregnancy is a preexisting condition. Unless you have had 18 months of prior coverage an insurance company wouldn't cover any maternity care until after the preexisting condition waiting period was over, and I believe that is about 6 months. OP, I'd do the research yourself.

Mrs.Syntax · April 2012

Are you saying that your DH is adding you on to an individual policy? Many individual policies do not cover maternity care at all. It doesn't matter if you have had insurance in the past. We have an individual policy because DH is a small business owner, and we'll be paying for everything OOP.

seraphiclust · April 2012

Since all states and insurance plans differ I would recommend your FH speak to his HR department about this. They should be able to tell him what will (and won't) be covered.

spritz · April 2012

It is in the HIPPA law that employer-sponsored group health plans cannot consider pg a pre-existing condition:

Are there illnesses or injuries that cannot be subject to a preexisting condition exclusion?

Yes, as follows:

Pregnancy, even if the woman had no prior coverage before enrolling in her current employer's plan.
Conditions present in a newborn or a child under 18 who is adopted or placed for adoption (even if the adoption is not yet final), as long as the child is enrolled in health coverage within 30 days of birth, adoption, or placement for adoption. In addition, the child must not have a subsequent, significant break in coverage (defined as 63 days). For instance, a significant break might occur if a parent lost his job and health coverage for himself and his family shortly after a child?s birth. This break will be discussed below.
Genetic information. For example, if a woman is found to have a gene indicating she is at a higher risk for breast cancer, she cannot be denied coverage if there is no diagnosis of the disease.

Here's the link from the gov website

YisraelAmmi23 · April 2012

You can call the HR dept, or find out specifically what plan you will have and call the insurer to find out what their coverage will be. I switched at about 6months last time and it was a seamless transition..I even only had to pay the new lower copayment, even though many of the services u/s had been done under my other ins.

ks3pink · April 2012

Please have him call his dept to find out for sure. There is no set law at this point because thank goodness Obama care is not official yet.

MrsHarlowC · April 2012

spritz:
I did some reading, and it doesn't sound like group plans can treat pregnancy as a pre-existing condition. I will also be switching insurance plans in July, and I'm nervous about it so I've been doing a ton of reading.

This...<<<<<<ex licensed health insurance agent. ALTHOUGH it does depend on the state.

MrsHarlowC · April 2012

spritz:
I did some reading, and it doesn't sound like group plans can treat pregnancy as a pre-existing condition. I will also be switching insurance plans in July, and I'm nervous about it so I've been doing a ton of reading.

This...<<<<<<ex licensed health insurance agent. ALTHOUGH it does depend on the state.

patientnwaiting · April 2012

thanks for all the replies. it is a group insurance plan (he's in a union) and the hipaa law applies. they are not allowed to treat pregnancy as a pre existing condition for group policies. he's calling monday just to make sure.

spritz · April 2012

ks3pink:
Please have him call his dept to find out for sure. There is no set law at this point because thank goodness Obama care is not official yet.

Several parts of the Healthcare Affordability Act of 2010 (that's the law's real name) have gone into effect. Do you actually even know what's in it?

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anyone good with insurance out there?

Re: anyone good with insurance out there?

Are there illnesses or injuries that cannot be subject to a preexisting condition exclusion?

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