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 on Help Smart Phone and MEL Magazine.

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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, and dwelling fire insurance. He’s also been featured on sites like Reviews.com.

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Reviewed by Daniel Walker
Licensed Auto Insurance Agent

UPDATED: Mar 19, 2020

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Pregnancy may be treated as a pre-exisiting conditions

Whether or not pregnancy is treated as a pre-existing condition depends on the type of plan involved. Under federal legislation, group insurance plans are required to provide coverage to pregnant women.

Women who are already pregnant when they buy an individual health insurance plan won’t be covered at all.

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Pre-existing Health Conditions

A pre-existing health condition is one that an applicant sought medical advice or treatment for prior to the policy being issued. The insurance company may go back six months in determining whether a pre-existing condition exists, but it has the option of going back further in an applicant’s medical history to make this determination.

Each policy is different, but medical conditions such as heart disease, cancer and high blood pressure usually fall into this category. Type 2 diabetes and asthma may be treated in this manner. In some cases, an injury requiring a series of medical treatments may also be considered a pre-existing condition.

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Pre-existing Conditions and Group Insurance Plans

Under the Health Insurance Portability and Accountability Act (HIPAA), a group insurance plan is specifically barred from considering pregnancy as a pre-existing condition. As long as the plan covers maternity care, a pregnant woman who is a plan member or the dependent of a plan member must be covered for her prenatal visits and care, as well as the delivery.

A woman who changes insurance plans from one individual plan to another is not covered under the provisions of HIPAA. If the coverage is changed from a group plan to an individual one, the woman may not be covered for any pregnancy-related health care expenses at all.

COBRA offers coverage for people who were covered by a group health insurance plan but who have lost or changed jobs. This law applies to those people who worked for a company that employed at least 20 people. The catch is that to keep the coverage in effect, the former employee must pay the full cost of the premiums and administrative costs themselves. These health insurance rates will be higher than what they were paying before.

If the new employer has a group health insurance plan but new employees are required to serve a waiting period before they are covered, the COBRA plan can help to bridge the gap until the new policy takes effect.

The pregnant woman can also choose to serve out the waiting period and pay any health-related costs out of pocket herself. This option would probably be best if the changeover is taking place early in the pregnancy, and the woman is only looking at paying for one or two prenatal visits, as opposed to the costs associated with complications later in pregnancy or the delivery.

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Other Coverage Options

A pregnant woman with low income may qualify for Medicaid, which is an assistance program funded by federal and state governments. A pregnant woman may be able to get coverage under this option, but the criteria for acceptance vary by state.

In some cases, a person who is accepted for coverage will be asked to pay a deductible or co-pays for services provided. There are no fees associated with applying for this coverage, so the best choice is to apply anyway rather than trying to determine eligibility on your own.

Another option for low-income pregnant women is to get assistance from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The federal government provides funding for WIC, which offers health care services and nutrition counseling for pregnant women and their children under the age of five years. Women who qualify for Medicaid may also qualify for help from WIC. They must be identified as a “nutritional risk” by a healthcare provider.

A high-risk insurance plan may also be an option for a pregnant woman without health insurance coverage. These plans are available to people who have already been turned down for health insurance coverage and the type of coverage available varies by state.

Getting coverage under a high-risk insurance pool plan is an expensive way to get coverage, though. The premiums tend to be very high, and in some states there is a waiting period before coverage starts. Since the plan is state-funded, the individual’s name may be placed on a waiting list due to financial restrictions.

Pregnancy cannot be treated as a pre-existing condition under a group health insurance plan. Individual health insurance plans will not provide coverage to a woman who buys the policy after she becomes pregnant. Plan members should check the information booklet that applies to their policy for specific information.

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