Insurance Re Pregnancy

9 Replies
kerryv - February 16

so here is my story...I just tested today and am pregnant. my husband lost his job (and our insurance at the end of January) we quickly found an individual plan and it becomes effective 2/20. yes this was a surprise pregnancy and I am still trying to figure out the hows and whys BUT most importantly. does anyone know if it is considered a 'pre existing condition' or not? I read online that HIPAA doesnt allow pregnancy to be considered a pre existing condition and the definition is that if you have not seeked medical advise, treatment, etc within 6 months prior to effective date than you are ok. thoughts or advise?


tryingx3 - February 16

Did you take COBRA in between or have you been without coverage?


tryingx3 - February 16

I don't know the answer to your question, but since you have not sought medical advice for your "condition" and are so early - I would think you would be okay - to discover it after your insurance goes into effect...


kerryv - February 16

no, we didnt do cobra bc it was too expensive but we do have 'gap insurance' so we ahve not been without.


Jennbj - February 16

Oh, I am so glad you asjed this question. I had a similair situation so Ilooked into it. HIPAA rules only apply to group insurance, so through an employer, it cannot be considered pre-existing. . Unfortunately the same rule about the pre-existng condtion doesn't apply to individual plans. They can do whatever they want and believe me they will. I sadly, didn't look into it soon enough as there are some other options out there if you get into it before a certain amount of time. I went into all this with an actual insurance agent, so I would reccomend you get with someone who can help you look at all the available options. I hope this helps in enough time, since I didn't start the process soon enough and was stuck with the bill.


sarah21 - February 16

Individually it can vary but the majority do not consider pregnancy a pre-existing condition. I don't know what your income level is but you also may be eligible for state aid, depending on your state. I live in Texas and they have expanded the medicaid program to include a lot higher incomes than it used to, so check into it.


kerryv - February 16

so how do I go about finding out if my insurance will cover it before I start looking elsewhere?


Heather - February 17

I am an insurance agent and pregnancy is NOT considered pre-existing. However, most individual policies do not cover maternity. I know in Texas anyone that is pregnant qualifies for medicaid regardless of your income. You can call the insurance company to find out if they cover maternity. Most of the time they will cover complications from pregnancy but not the pregnancy. I hope you are able to get the right coverage!!! You should also have 60 days to elect Cobra coverage and you can elect it on just yourself in order to get the maternity coverage. Cobra is expensive but if it is less than the cost of having a baby and your individual plan doesn't cover it then I would say it is worth it. JMO


kerryv - February 17

thank you- I did elect the maternity rider though so that will cover all the prenatal/postnatal and delivery charges, of course after our deductible is met. so in all reality, we should be fine...I suppose I will know when I go to the ob/gyn in a few weeks and they bill them, right?


Samoria - March 3

If you're in CA, there is a chance private insurance companies will turn you down due to being pregnant. It happened to me. "Pre-existing" they say. HOWEVER, if you're in California.... PLEASE look into a state program called AIM. (Access for Infants and Mothers.) It's a state run health insurance *only* for pregnant women. And it's heavenly! It cost me like $15 a month for the entire thing, and I got to choose a Sutter doctor who was excellent. It's funded by state tobacco tax. It's great to know that the State of CA understands that prenatal care for women is incredibly important and they offer such a program. If you're not in CA, see if your state has a similar program.



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