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Can the new insurer claim that my pregnancy is a pre-existing condition and not approve coverage?

Since your health insurance gap is less than 63 days, you should qualify under HIPAA and your pregnancy should not be considered a pre-existing condition.

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The Health Insurance Portability and Accountability Act was designed to protect workers and their families in situations similar to yours. Before the law was enacted in 1996, workers sometimes felt locked into jobs because they feared losing their health insurance coverage if they went to work for another company.

Title 1 of the law limits group plans from imposing eligibility rules or assessing premiums for people based on their health status, medical history, genetic information or disability. For example, if you've had health insurance through a group health plan for 12 months, with no coverage lapse of 63 days or more, a new group health plan cannot exclude you because of a pre-existing condition. It has to cover your medical conditions when you enroll.

However, your husband's new group health plan will cover your pregnancy only if it already includes maternity benefits. Some states mandate that group health plans cover maternity, and many employers provide the coverage even in states that don't mandate it. Still it's a good idea to check.

 

Read more about HIPAA: your rights to health insurance portability.

Last updated: Nov. 4, 2010
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