Will VA Insurance Cover Me If My Fiance and I Get Married When I Am Already in the Second Trimester?

The time to purchase individual health insurance coverage is before a potential health condition or risk factor arises. Because of the high likelihood of significant medical costs, and the potential for adverse selection, health insurance companies do not sell individual policies to people once they become pregnant. However, you can still get access to health insurance through an employer-sponsored group insurance plan, either by getting a job yourself or by marrying someone who is covered and joining his plan.

Group Health Insurance Plans

• Employers, associations and any group of persons with a common interest other than forming a group for health insurance may form a risk pool for health insurance risks. In the workplace, employers must provide health insurance coverage for all qualified employees. They cannot discriminate against employees on the basis of their health or age. They must also typically guarantee the insurance company a minimum level of participation in the insurance plan. This helps guard against adverse selection, or the tendency for healthy people to opt out of insurance coverage, leaving only the sick in the risk pool, driving premiums to untenable levels. In exchange, health insurance companies must grant coverage to all qualified employees.

Enrollment Periods

• Group policies routinely impose open enrollment periods. New employees, for example, must enroll in the health plan when they first become eligible for coverage. Otherwise, they must wait until the next open enrollment period. This open enrollment period also applies to the employee's family. However, federal law requires employers to allow new people to enter the group through marriage without waiting for the next open enrollment period. If you marry someone covered under an employer health plan, you can get covered right away.

Pre-existing Conditions and Pregnancy

• The law allows insurance companies to limit coverage for pre-existing conditions for a period of 12 months from enrollment in the plan, if there was a break in coverage of at least 63 days prior to the person's enrollment. However, federal law prohibits group insurance plans from rejecting coverage because an individual is pregnant. Pregnancy is exempt from the pre-existing conditions rules.

Maternity Coverage

• Plans vary among employers, but Virginia is among the states that mandate that insurance companies must offer maternity care. You may have to pay the costs of routine pregnancy tests and checkups out of your own pocket, depending on your deductible and the details of your employer's plan. You will, however, be able to enroll in your new spouse's medical plan, if he is covered at work, even if you are pregnant.