Is Pregnancy Considered a Pre-existing Condition?

It is not. I called blue cross to ask them the same question when my sister-in-law was planning on getting pregnant.

there is an IL law that as long as you don't have a lapse in coverage of over 30 days no condition is preexisting

Hi MK --

I just went through this myself and have recently done TONS of research. I just changed jobs, at 8 weeks pregnant, which involved changing insurance plans and I was concerned.

The HIPPA law prohibits insurance plans from considering pregnancy as a pre-existing condition. You can find more information about this via the following website from the Dept. of Labor http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html

According to DOL:

"Moreover, under HIPAA, preexisting condition exclusions cannot be applied to pregnancy, regardless of whether the woman had previous health coverage. In addition, a preexisting condition exclusion cannot be applied to a newborn, adopted child under age 18, or a child under age 18 placed for adoption as long as the child became covered under health coverage within 30 days of the birth, adoption or placement for adoption and provided that the child does not incur a subsequent 63-day break in coverage."

You must keep in mind that HIPPA does not apply to individual health plans. But if you are switching from one group plan to another group plan via your husband's employer, you will be fine. HIPPA also does not necessarily apply to some employers, mainly those with 50 employees or less.

Finally, you may find that the new health insurance policy does not even have a pre-existing clause at all. Not all insurance plans even impose a pre-existing condition clause. I spent a lot of time researching this just to find out that my new employer does not even have a pre-existing clause! So, even things that WOULD be considered a typical pre-existing condition, like asthma, diabetes, etc, are fully covered with no waiting period.

Basically, you don't have anything to worry about as long as you are going from one employer group plan to another.

Good luck.

Yes it is! I was pregnant with my daughter using my own insurance, not my husband's. My insurance plan changed and it was going to be extremely ridiculous. We decided that my husband add me to his insurance but they didn't want to cover the pregnancy because it was a "pre-existing condition". He spoke to his insurance coordinator, we showed them what my new plan would be and they agreed to go ahead and cover the pregnancy because my plan was just ridiculous. Otherwise I don't think they would have taken me on and it would have ended up costing us a lot of money.

I also remember reading that insurance companies could no longer deny coverage using pregnancy as a pre-existing condition but i'm not 100% sure...I do know that I have been through three pregnancies and for two of them our insurance changed during the pregnancy and I had no problems recieving coverage. Sorry I didn't have more info for you...hopefully someone will know the details :)

As long as you have had continuous insurance coverage for 18 months prior to the switch and it is a group plan through an employer they can't deny a preexisting condition. Yes pregnancy is considered preexisting.

In 2003 I was laid off at 3 months pregnant. My husband's insurance picked me up right away and covered everything. I would contact the new insurer to be certain since your situation is different.

I didn't deal with a pregnancy but my son has a medical condition. When I lost my job, I took COBRA for that very reason. Then when I got a job, I had to have a certificate stating I had group insurance with 63 days or less lapse(this is under HIPAA rules). When I chagned my insurance because the doctor I really wanted was under the new plan, I did not have a problem. If the change is coordinated correctly, you shouldn't have a problem either. Issue may come up if you have private insurance or swithcing to it though it doesn;t sound like that is the issue. You can check on line for Hipaa rules. There is some info on wikipedia also.

I lost my job at 3 months pregnant and was transferred to my husband's insurance without a problem. I went from Blue Cross to United Health and they, UHC was actually better for me in the long run. There were no problems at all. Talk to your new insurer, pregnancy isn't a long term "illness", although you may feel that way in the last month!(haha) you really cannot be denied insurance for being with child.

My husband's company switched insurance providers in the middle of my last pregnancy and it took up where the other left off. Unfortunately the coverage wasn't as good and we had to pay more out of pocket, but I was still covered. I don't believe they can deny coverage for such a thing. If you know what insurance company they are going with call and find out.

I am a licensed insurance rep, and from what you are saying, as long as there is no lapse in your coverage, and the new policy carries maternity coverage, you should be fine! The key is that your new policy has maternity coverage, because, not all policies do!! And make sure that there is not lapse in coverage, then there could be a waiting period, or exlusion for certain med conditions......

If you are switching insurance just due to the company is making the change in insurance companies it, nor any other pre-existing condition can be held against you if it is a group insurance change. If you are switching a policy that you purchase individiually that is another story. But Group policy changes you should be fine!!!

DRG

Just went through this 10 mos ago as my OB was not in the new insurancy converage so I was devastated. Through a lot of mess I was using "transition of care" and it worked and didn't pay a penny however it was a total headache, but worth it. The new insurance or old can't remember, has to write a contract and they approve it. In my case I had HMO and they only took PPO so they ended up paying them like I had PPO. If you have any questions, email me!

You are absolutely right. The insurance has to cover your pregnancy. I read the same clause in my other insurance policy, too. Good luck! :-)

It depends on what kind of insurance you have. If you are moving from large group (eg. employer sponsored) to large group and you have no breaks in coverage of more than 63 days, then you cannot be subjected to pre-exs including pregnancy riders. But in the individual market, you can have a pre-ex of up to a year and a lot of policies in the individual market do not include pregnancy coverage and when they do, it is really skimpy coverage. So this is an area for great caution. You can call the Division of insurance for help or the Attorney General's office.

If you are continuously covered, as in, there is not a 2 week (or even one day honestly) gap between one insurance and the next, all you will need (if the insurance company even asks) is an 'evidence of insurability' form from your last insurance company. you can either ask for it, or they will automatically send it. If you are only a couple weeks along, when it switches, this is a mute point anyway.

Good luck with #2. If you are still concerned, speak with the HR department (your employer.... his??) and verify with them. If it's a company provided plan, chances are extremely high they plan these things to be seamless and you'll be just fine...with no gap in coverage.

In all of the insurance policies I have read, pregnancy is not a pre-existing condition. Be sure however to read your policy. If it is a simple change over from one carrier to an other there should be no waiting period. It should just be continued coverage. When I was pregnant with my second child we switched from BCBS PPO to Aetna PPO and had no problem.

I suggest you call the IL dept of Insurance or a couple of individual insurance companies. Also, find out if you are covered for c section or any unexpected problems/issues you may have.
Good luck.

If the company changes the insurance usually the pregnancy or anything else that was covered by the old insurance is covered. I remembered when my husbands company changed we had to fill out a form asking us every health issue that we all had etc and one question was pregnancy. I made the mistake of not saying I had asthma, boy did I have touble was that, I had to get all kinds of paperwork from my dr saying I did have it pryer to changing etc. They should give you paperwork to fill out if you are pregnant before changing, if it is job related. Good Luck on trying to get pregnant.And make sure you fill out all the pre-exsiting conditions you all have.

It is considered a pre-existing condition and most insurances will not cover you! My husband and I looked into this because we were afraid of downsizing. Call and ask everyone involved: insurance, HR, state multiple times. You want to make sure you're covered otherwise you are responsible for the hospital bill. I personally know someone that did file paperwork on time "thought they were covered" and ended up with the bill and nothing had changed with their employment. I would suggest waiting until you have your new insurance or a clear understanding before starting to try again. The exception is that you and husband make under the amount to qualify for medicare/WIC. http://www.dhs.state.il.us/page.aspx?item=30513. Best of luck with the insurance and getting pregnant again! Having 2 is wonderful :)

My experience says that it is a pre-existing condition. I tried to go from employer insurance to an individual family plan a few years back. I ended up quitting my job and taking a COBRA plan from my former employer. There are enough varied answers that I would just ask your current insurance company directly. Good luck.

I was nine months pregnant when we had to change insurance companies and we were not denied. I would hope that is across the board.

Good luck,
A.

Hi! Congrats on your pregnancy!

As a woman living with leukemia, I have become well versed in many topics dealing with insurance and your rights.

In Illinois, they have passed a law that states no matter what disease or "condition" you may have, as long as you do NOT have any lapse in coverage, you can not be deemed to have a pre-existing condition. So in other words, if you go from insurance to another insurance, your fine. If you go from insurance to cobra to another insurance, your fine. Just do not lapse in coverage, not even one day!

Good luck to you and congrats again!
B.

My experience has been if there is no lapse in coverage you're fine. In other words, make sure the new coverage is in place before you cancel your current coverage.
I just did this myself. I'm currently 8 months pregnant. We had coverage thru my employer and switched to my husband's new employer. We just made sure his new coverage was in place before we cancelled our old coverage.

I had this same situation last year. My insurance did consider it a pre-existing condition; however they stated that I needed to provide a certificate of credible coverage and then they would be able to cover it. The best thing to do is call the insurance company; they will be able to tell you. Good Luck- Becky

Nope - it does not fall under preexisting - You can't be denied coverage - especially if you currently have coverage and there is no lapse.

I'm sure I am repeating another person's response, so I will be brief. If you are insured when you become pregnant, you do not have a pre-existing condition. Maintain your coverage -- no lapse in time -- from insurance to insurance and you will have no problems.

Same happened to me...the answer no. The only thing that was different was I had to pay another copay and the ending payment was more, but still covered. The only that stunk on my end was I had to change docs, b/c the one I had before was not covered on the new insurance. I just asked my doc for one on my policy that delivered at the same place and ended with a great doc!

I was recently told by my boss that as long as your insurance coverage has never lapsed, pregnancy cannot be considered a pre-existing condition. So as long as you haven't been completely without insurance you will be covered (and I believe even then you have to be without insurance for at least six months before they can deny you coverage). I suppose it depends why you're changing. If it's just that his company is changing plans to a more cost-effective plan, they can't deny you coverage. Hope this helps!

I am a Benefits Specialist with my company and I can tell you that it is not a pre-existing condition for medical insurance as long as you are just switching plans within your husband's company since there is no gap in coverage. You will be covered under the old policy until the plan changes and then you will start to be covered under the new plan. The policy states that there must be no great lapse in coverage than 63 days, however, I would not take that chance. For Short-term disability and stuff like that through your current employer there would be a pre-exisitng condition if you are already pregnant at the time you apply for it. Usually pregnancies get denied for short-term disability coverage, but if you are not pregnant yet and are very healthy, there should be no problems in getting the coverage. Hopefully this answers your question...good luck on baby #2 and the insurance switch!!!

I just had a baby this year, and our insurance changed when I was about 5 mo. pregnant from Aetna PPO to BC/BS PPO. The way that it is understood is that it is a pre-existing condition and as long as you don't have a gap in your insurance coverage the pregnancy is covered. However, if you know the new insurance company, I would call them and ask or I would contact someone from your Human Resource department, they may have a better understanding of how their insurance works.

I hope that I was able to help. Good Luck!

As a person who worked in Human Resources for a while, I can tell you THAT IT ALL DEPENDS ON THE NEW PLAN!!! USUALLY, and if (and only if) there is no lapse (even for one day) in coverage, your new plan should probably cover it. But like I said, it all depends on the new company's plan. Pregnancy is usually considered a "pre existing condition", so make sure you find out the details of the new plan before you cancel your old plan. HIPPA laws cannot let them deny you coverage due to pregnancy, but please, find out the details of the new plan, just in case...

Are you changing jobs? If so, ask your current employer what the guidelines are for COBRA coverage - you have a right (by law) to continue on with your current employer's coverage for up to 12 - 18 months after leaving that job. The catch is that you have to fill out COBRA paperwork on time and pay 100% of the premiums yourself (on time, or they can drop you). If you find that your new plan won't cover your pregnancy, your old plan should, which if you do a little research, you might find it cheaper to pay the premiums yourself, rather than the hospital bill for the pregnancy and delivery (especially if you have complications or need a c-secion). But this is only if you are changing jobs/companies.

Does your current company have a person in charge of the insurance? Chances are if you know that you are changing plans, they would already have the plan details. Contact them for the details.

Hope this helps.

Hi MK,

I would call the new insurance company and ask them. Or you could call the human resources department at the company where your husband works as they should be familiar with the insurance policy coverage. The same thing happened to me...I got pregnant in October and my new insurance kicked in January 1st of the next year. They covered everything as they did not consider pregnancy a pre-existing condition even though I had IVF. It might be different with different insurance companies. Best of luck to you on #2!

Hello,
As long as you are on a group plan, you have no worries. If they change from one carrier to another, there is no pre-existing. In fact if you had NO insurance and got onto a group plan, Pregnancy is the only thing that ISN'T considered a pre-existing condition. It is the federal law.
So relax and enjoy your pregnancy! C. B.

Hi MK,

You absolutely want to speak with your insurance company or HR contact. Every policy is different and you don't want to be stuck with tens of thousands of dollars due to clerical dates and insurance changes. Since you are already trying, if you are already pregnant and don't know it, there should be some sort of COBRA option available for your final few months so that you're covered. Do the research though!!!

Good luck,
MC

Pregnancy stopped being considered a pre-existing condition on July 1, 1997 but most companies did not enact the policy until January 1, 1998. The reason I know this is because I was pregnant before July 1, 1997 with my first son and had to pay out of pocket for that pregnancy. My husband and I always joke that our son did not actually belong to us until he was 18 months old since it took that long to pay off the hospital!

I just went through this as well and checked with my OBGYN and employer. But, was told by both that as long as the OBGYN uses the new plan that the Employer uses, there shouldn't be a problem. Also, there was a law passed on the Federal level stating that insurance companies CAN'T descriminate against you for pregnancy as a pre-existing condition. I believe this was part of Clinton's Family Leave Act.

Pregnancy is NOT considered a pre-existing condition for insurance. But do check the policy to see what type of coverage they have for prenatal testing during pregnancy. And what will be covered for the baby and other children as far as vaccinations. We had a Blue Cross Blue Shield PPO that only covered $300.00 for vaccinations when my daughter was born and my husband didn't know it and we are stuck footing the bill for about $1500.00 for vaccines for her. Had I or my husband read all the fine print we could have taken her to the county for free vaccines.

Hi M K,
If you are being covered by an employer than you will be covered. If you are insured individually than you may not be covered. Some insurance companies make you wait 1 year before they will cover pregnancy costs. Also make sure the new insurance has your Dr. on their list of preffered Dr.'s. You don't want to have to switch Dr.'s in the middle of your pregnancy.

I've been through 3 pregnancy and 2 insurance changes. Fortunately I was lucky and the new coverage just picked up where the old left off. I think if you are covered when you get pregnant, then they don't say anything when the switch occurs. If you know what the new company will, call and ask them. I'm sure they would be happy to help. Good luck.

HI M K,
I would recommend you talk to the HR person, if your husband is starting a new job, it could be one answer, but if the current company is switching insurance, the answer could be different. More than likely if he is staying at a current position it will be covered. If he is switching jobs, that could depend on the insurance of the new company. Basically, a phone call to the HR department could ease many of your concern about how to proceed in either event.
Congrats on the pregnancy and good luck.

I went through this same thing when I started a new job. My insurance company said that since pregnancy is only temporary, it would not be considered a pre-existing condition and that I would be covered.

Hi,

I had the same issue this past January. I went from having insurance through my work to having insurance through my husband's. Other than having trouble getting Hinsdale Hospital to process the first two appointments correctly (their issue, not the insurance co.) we didn't have any trouble getting the new insurance company to pay the bills.