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Ask the Health Insurance Expert

I just started a new job, and my employer-sponsored health insurance will be effective in six weeks. What happens if I get pregnant before I'm covered by the company health plan?

As long as the new health plan includes maternity benefits -- and almost all group plans do -- it has to cover your pregnancy once you are eligible for coverage. The insurance plan cannot exclude your pregnancy as a pre-existing condition, according to the federal Health Insurance Portability and Accountability Act, known as HIPAA.

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Be aware, though, that some other conditions could be excluded from coverage for up to 12 months if you went without health insurance for a significant period in the last year.

Among other things, HIPAA was enacted to preserve continuity of health insurance coverage so workers could move from one job to the next without fearing the loss of coverage for pre-existing conditions. The law says an employer-sponsored group health plan can't exclude coverage for pre-existing conditions as long as you maintained "creditable" health insurance for the last 12 months. That means with no coverage breaks of 63 consecutive days or more. However, the group health plan can't exclude pregnancy as a pre-existing condition, period -- even if you didn't maintain coverage in the last year.

The new health insurance plan, however, will not cover any services you use before it becomes effective. Unless you have other coverage, you'll have to pay out of pocket for any doctors visits or other medical services until you become eligible for coverage in six weeks.

For more, see HIPAA: Your rights to health insurance portability.

Last updated: Mar. 20, 2012
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