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Is pregnancy considered a pre-existing condition under a disability insurance plan?

Chelsey Tucker graduated with a Bachelor of History degree from Metropolitan State University in 2019. She now writes about insurance with her specialty being life insurance and has been quoted...

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Dan Walker graduated with a BS in Administrative Management in 2005 and has been working in his family’s insurance agency, FCI Agency, for 15 years. He is licensed as an agent to write property and casualty insurance, including home, auto, umbrella...

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UPDATED: Mar 19, 2020

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Depending on the language of the insurance policy, pregnancy may be considered a pre-existing condition under a disability plan.

Private insurance companies can determine their own policy language and some of them will not consider pregnancy a pre-existing condition but will not pay any benefits that are associated with pregnancy unless the policy has been in effect for at least 12 months.

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The exception to the rule is a situation where the pregnant woman is enrolled in a group disability insurance plan through her employer. A woman who is thinking of becoming pregnant should buy disability coverage before she conceives to get the benefits this type of insurance can offer.

Definition of Pre-existing Condition

A pre-existing condition can be defined as a condition for which the insured consulted a medical practitioner before a health insurance policy, including one offering disability benefits, was issued. Medical issues, such as high blood pressure or diabetes, are commonly considered pre-existing conditions.

Rather than refuse to provide coverage to an applicant who has a pre-existing condition, the insurance company may issue a policy but refuse to cover any claims stemming from the pre-existing condition for a set time, say 12 months.

If an insurance company considers pregnancy a pre-existing condition, it will set the exclusion period to at least nine months, so that claims relating to it will not be covered. If the woman fits the criteria for disability set out in the policy for another reason, she will be covered. A disability-related claim relating to subsequent pregnancies will be covered.

Pregnancy as a Disability

Pregnancy doesn’t normally fit the criteria for disability, since most women are able to continue their normal activities, including working, during this time. There are some pregnancy-related conditions that can interfere with a woman’s ability to work, such as incapacitating morning sickness.

Other medical concerns, such as elevated blood pressure or concerns about a threatening miscarriage, may mean that an expectant mother is put on bed rest by her doctor. In those situations, disability insurance coverage can replace a certain percentage of her income.

Childbirth and complications that may occur during the process are generally covered under maternity disability coverage. The policy will provide replacement income benefits for a certain number of weeks following a vaginal delivery; if the woman has a Cesarean section, she is entitled to collect benefits for a longer time.

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Employer-Sponsored Group Disability Insurance

Employer-sponsored group health plans fall under the scope of the Pregnancy Discrimination Act and must cover pregnancy and pregnancy-related claims. If an employer offers temporary disability coverage to other employees, it must also extend these benefits to pregnant employees as well.

All pregnant women, whether they are covered by an employer-sponsored disability insurance plan or a private one, should familiarize themselves with the terms of their coverage. The policy will likely have certain exclusions, which means that the insurer will only pay out benefits under specific circumstances. The woman should review the policy language to familiarize herself with how the policy works and how and when she should file a claim.

The pregnant woman needs to provide medical documentation of her illness and the estimated date she is expected to be able to return to work. Once the claim starts to run, the insurer may need to receive updated information while the woman is away from work or it may refuse to continue paying benefits.

The rules about pregnancy and pre-existing conditions for disability insurance can be complicated. If the policy is an individual one, the insurance company can set the policy terms it chooses. Some plans are more generous with what they cover than others, but be prepared to pay more for ones offering a higher level of benefits or shorter exclusion periods. Before applying for one of these policies, a consumer needs to do her homework to make sure that she will be adequately protected if she cannot work during pregnancy.

Employer-sponsored group disability plans work in a different way. These types of insurance plans must cover pregnancy and pregnancy-related conditions. Some employers only offer unpaid disability leave, so it’s important to check out the benefits offered in detail before illness forces a pregnant woman to stay off the job. Even though she is unable to work, she still needs to cover doctor’s visits and the hospital stay when she delivers.

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