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Hospital Indemnity Coverage California

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  • Hospital Indemnity Coverage California

    This might not be the right place to ask this question, but it's worth a shot.

    We have a high deductible Kaiser health care plan. On July 1, 2015 we started a separate hospital indemnity gap coverage policy because we knew we were hoping to have another child and it would help with labor and delivery costs. The policy has a pre-existing pregnancy clause that won't cover any full-term deliveries within 9 months of the policy start date. This date would be April 1, 2016.

    I was not pregnant when the policy started, however, I am now, and my due date is March 31, 2016. A pregnancy is counted back two weeks from conception to the last menstrual period. Also, a baby can be considered "full-term" at only 37 weeks. Therefore, I am pregnant now, due to give birth within the 9 month exclusion period, yet this pregnancy is NOT pre-existing.

    Obviously, I am hoping just to go overdue a few days and give birth outside the 9 month exclusion period. However, if I give birth between March 10, 2016 and March 31, 2016, what are the chances I will be able to claim the birth and receive payment from the hospital indemnity policy?

    If someone can suggest a better place to ask this question, I'm all ears. Thank you.

  • #2
    Someone's missed the boat somewhere. Insurance carriers are no longer allowed to deny claims on the basis of pre-existing conditions, and LONG before that was made law (two years ago) pregnancy was excluded from any pre-ex clauses.

    Where did you get this coverage from?
    The above answer, whatever it is, assumes that no legally binding and enforceable contract or CBA says otherwise. If it does, then the terms of the contract or CBA apply.

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    • #3
      It is a Colonial Life policy. I had the same thought initially, but I was told because it is a "gap coverage" and not a primary health insurance, it didn't fall under the same laws protecting against pre-existing clauses. Was I misdirected with this information?

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      • #4
        It seems from what I have read several places that at least some health gap policies are generally short term coverage with limited benefits, do not cover pre-existing conditions, are not ACA compliant & are not guaranteed issue.

        You will need to read your policy provisions.
        Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around. Leo Buscaglia

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        • #5
          Is it a short term policy? I can't find anything excluding gap coverage, per se, from the regulations but some short term policies can be.
          The above answer, whatever it is, assumes that no legally binding and enforceable contract or CBA says otherwise. If it does, then the terms of the contract or CBA apply.

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