Health Insurance Quotes
Ask the Health Insurance Expert
I am being told that my wife's pregnancy is a pre-existing health condition. Our health insurance policy recently changed to include higher out-of-pocket expenses. My employer offered me a group hospital indemnity insurance plan that will help offset those costs, but the provider says her pregnancy will be considered a pre-existing condition. Can they do that even though I've had a group policy with maternity care for years? I hope you can help shed some light on this for me.
Pre-existing conditions should be covered in group plans as long as you had health insurance coverage for 12 months prior to enrolling in the new plan, with no coverage gaps of 63 days or more, according to the federal HIPPA law. Employer-sponsored plans can apply exclusions for pre-existing conditions for a certain period of time, usually 12 months, if there was a gap.
Unless you had a coverage gap, the information you're getting from the provider is puzzling.
Talk with your employer's human resources manager who handles medical insurance benefits, and check with the provider again. Don't take the word of the insurer’s customer service representative who answers your call. Ask to speak to a supervisor if you believe you're entitled to coverage.
If you still feel like you're getting nowhere, check with your state's department of insurance about your rights. States oversee the insurance industry, including health plans, and respond to consumer questions and complaints.
To find your state insurance department, check Insure.com's state insurance information page. Click on the state name for a link to the department's website.
For more, see and what is a pre-existing condition, exactly?