Is Pregnancy a Pre-Existing Condition for Insurance?

Insurance is very important to pregnant women. Adequate health care reduces the risk of pregnancy complications, and it involves plenty of medical attention and costs. Insurance helps to defray those costs, but only if pregnancy is covered. There are several things to consider when determining if pregnancy is a pre-existing condition.

Significance

• Pregnancy is extremely expensive. Medical costs during pregnancy include routine obstetrician visits, medical tests such as ultrasounds and blood work, and the hospital bill for delivery. If an insurance company does not pay for pregnancy-related expenses, the cost for the expecting mother is extremely high.

Considerations

• A woman has the right to get pregnant whenever she wants. If an insurance denies coverage due to pregnancy, it is the patient's right to self-pay. When deciding whether to get pregnant, assess all implications, including insurance and finances.

Time Frame

• Many insurance companies refuse to cover care for conditions when there is a lapse in coverage prior to enrollment. If there is a period where a woman is not covered, an insurance company can consider pregnancy pre-existing and refuse to cover the expenses. This includes lapses that occur when waiting for eligibility for a policy, such as when changing employment.

Effects

• HIPAA, or the Health Portability and Accountability Act of 1996, helps ensure that insurance covers pregnancy in some cases. However, it only pertains to specific insurance coverage types, so pregnant women need to be careful when making decisions that may affect heath care when they are pregnant.

Features

• HIPAA prevents insurance companies from considering pregnancy a pre-existing condition to deny coverage. This ensures that if a woman changes group health care policies while pregnant, the new insurance policy will cover pregnancy-related expenses.

Misconceptions

• Pregnancy is not a pre-existing condition, but there are several loopholes that allow insurance companies to deny coverage to new enrollees who are pregnant. HIPAA also only covers group health insurance policies, not individual policies, and individual policies can consider pregnancy a pre-existing condition.

Warning

• Lying about a pregnancy conception date is never a good idea. The doctor has to know what the conception date is in order to properly assess the health of the baby's development. It may jeopardize the baby and mother's health if the doctor has an incorrect estimate of the conception date. Also, an ultrasound will accurately determine the date, so the truth will come out eventually.