I gave notice to my employer in Nov 07 that I was expecting a child in May. At that time I was not enrolled in STD however I was advised to enroll for salary benefits by my HR department. They said I had to wait for open enrollment which was later that month and it would be in effect on Jan 1. Now it is March and I have been notified that my enrollment papers have been misplaced. I had to fill out the forms a 2nd time only 8 weeks before I am due. I was told that either way I may not have qualified for STD in for this claim as it may be viewed as a pre-existing condition. I have some HR understand and believe that had they turned the forms on time there would have been a great chance that I would qualify. I have not heard from the company that provides our STD yet to confirm anything however I am very frustrated with my HR department. They after all had plenty of time to get things in order.

My question is in two parts.
1. Based on the information provided is it possible I would qualify for STD?
2. If due to my company loosing the forms and if I am disqualified for this claims because of this. Is there any liability on there part?

If there is a pre-existing clause, you were just as pregnant in November as you were in January as you are now and it would not be covered. I've never heard of a policy covering a pregnancy that was already underway. It *may* cover if there are later complications but your delivery itself would not be covered no matter when your forms were processed.

1.) That would be impossible to say without reading your STD policy. It is by no means outside the realm of possibility that your pregnancy would be disqualified as a pre-existing condition. HIPAA prohibits HEALTH insurance plans from considering pregnancy as a pre-ex condition; there is no such restriction on STD plans.

2.) IF it can be established that the sole reason you did not qualify was due to negligence on the part of their employer, they might be required to provide you with the benefits you would have received.

Hello,
Thank you all for your previous feed back.

I just received confirmation from my HR Department that I was approved for STD coverage retro actively as of Jan 1, 08. My question now is when I file the claim for my leave (6weeks) is there a possibility that my claim could be denied. I am not due until the end of April.

Thanks.
SMY

It depends on what the policy's provisions for coverage of pregnancy are. Both of the STD policies we offer only cover pregnancy if the birth occurs more than 10 months after the effective date of the policy. Do you know what yours says?

Is there a possibility the claim will be denied? Yes, it is possible.

Will it definitely be denied? Only someone who has read your disability policy can answer that.

I just got the policy provisions faxed to me. The waiting period is 30 days of contnuous Active Work however no where does it mention anything about pregency exclusions or waiting periods. Could it possible 30days applies to all claims or am I missing something?:confused:

Without reading the policy, we can't possibly say. We cannot interpret a document we have not read.

You're probably better off asking your HR department.

My employer told me to send in my claim to our vendor which I did even though I have not delivered or stopped working. I thought that to be odd since usually you are not suppose to file a claim for benefits until after then need arrives. Anyhow a I thought my claim was processed and put on hold until after I deliver. In the letter they did not say anything about being denied benefits just to I would have to call them to update my claim once I deliver. Is this good news with regard of have my claim approved or am I reading too much into it?

Just to recap: My STD coverage was approved starting Jan 1 2008 with a 30 day wait period for claims. It is now April and I am 37 weeks PG with an EDD of May 3rd. My concern was not being eligible for beneftit for this claim since I was diagnosis PG in October 2007. However no where in the coverage does it state pre-exisiting clause denial for pregnancy.

Again, having not read the policy, we can not say. A denial wouldn't be issued until you actually make a claim for benefits. I have never heard of a policy that didn't have a pre-existing clause, though it is rarely unique to pregnancy. Anything is possible but we can't tell you the terms of a plan we have not reviewed.

You need to ask your HR department to answer your questions directly. If they don't know, they need to get on the phone with the insurance provider for you.

I was in the same boat as you with my employer three years ago, and the claim was not denied until I updated it after I delivered. That is not a fun call to get a week after you've given birth.

It all varies by company. When I took my STD due to my pregnancy the company that my STD went through stated that there was a 14 day waiting period from the time I filed until the time I would start receiving my benefits so during that 14 day waiting period I used up what personal/sick/vacation time I had on the books and then STD took right over. Now there is a cap on the amount of STD you can take and after that I will switch over to LTD (I paid for that option through my employer) and that will cover me until I return to work (6-8 weeks after delivery depending on how I deliver).

Yep, Motherof4, I'm starting to agree with cyjeff's response in a similar post. What occurred with you, since you were not eligible for FMLA, was strictly up to your employer. Period. Plus, this original post is over 6 weeks old. I'm sure the poster has the information they need by now.