Hi,

I got a new job in January and my new employer insurance started in Februry. I discovered that I am pregnant in last week of February.

Prior to this job, I had an individual insurance for 3 months. I graduated last year and my school insurance covered me till August' 06. I had a break in insurance for roughly around 70 days before I took the individual insurance which didn't cover maternity.

Will my current group insurance cover my pregnancy or will it be denied as pre-existing? I don't think I am covered under HIPAA as my old insurance was an individual insurance. My current group insurance plan document has this line: "The pre-existing condition exclusion does not apply to pregnancy nor to a child who is enrolled in the plan within 31 days after birth, adoption, or placement for adoption".

Can anyone tell me whether or not my pregnancy is covered. This group insurance plan is administered in Virginia by Aetna (VA small group PPO).

Thanks,
Worried soon-to-be-mom.

The only way to find out for sure is to ask the Insurance company.

http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html

If you scroll about two thirds of the way down the page, you will see that HIPAA prohibits an insurer from considering pregnancy a pre-existing condition regardless of whether the employee had previous health insurance or not. HIPAA still covers you in this case.

Thanks CBG. That helps a lot and I can breathe a little more easily now :) .

I was worried that HIPAA won't apply to me as I had individual coverage before my current group insurance. I got that impression from the following link:

http://parenting.ivillage.com/pregnancy/phealthcare/0,,midwife_46wb,00.html
which says this:

"HIPAA applies only to group health plans. So if you have individual insurance and are pregnant, then buy group health insurance, you again could be subject to a preexisting condition waiting period. Likewise, if you move from one individual health plan to another individual health plan, you might not get pregnancy coverage at all. You might have to sit out a waiting period, or if you are offered insurance that covers your pregnancy, you might find it's very expensive. "

Whoever wrote that, failed to take into consideration that HIPAA expressly prohibits an group insurance carrier from considering pregnancy a pre-ex condition, regardless. In many, but not all, cases the link would be correct. It is NOT correct with regards to pregnancy. As long as you are covered on a group plan at the time of the birth, it will be covered, as will any part of the pregnancy for which you are on a group plan.