Health Insurance & Pregnancy Coverage

For many women, health insurance is a concern when they find out they are pregnant. The good news is pregnancy cannot be considered a preexisting condition by group plans under federal law. But there are loopholes that could affect expectant parents.

HIPAA

• The Health Insurance Portability and Accountability Act of 1996 (HIPAA) prohibits group health insurance companies from considering pregnancy a preexisting condition for the insured and dependents. If there is a change in group health insurance plans during a pregnancy, the new company is obligated to cover the pregnancy, provided there was continuous coverage for at least 12 months without a significant break in coverage.

Loopholes

• The bad news is that this provision under HIPAA only applies to those who were already insured under a group plan. If there was no health insurance in effect when the pregnancy was diagnosed, the pregnancy can be considered a preexisting condition. Insurance companies often enforce a waiting period for preexisting conditions which may extend beyond the length of the pregnancy.

Types of Coverage

• HIPAA mostly pertains to group health insurance plans. Changing from one group insurance to another will not result in a gap of coverage. However; if the health insurance moves from group to private coverage, the preexisting condition waiting period may apply.

Considerations

• Women should ask questions and make sure their pregnancy will be covered if they choose to change health insurance plans. Medicaid is also an option for low income families that meet the plan's eligibility requirements. The Centers for Medicare and Medicaid Services recommends applying for Medicaid through the state Medicaid office if the family income is low.