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Ask the Health Insurance Expert

I am employed with a company that offers group health insurance for which I am eligible but not enrolled. I found out I'm pregnant and need to enroll in the group policy to cover my pregnancy, but need to know if it will be considered a pre-existing condition.

If the group health plan covers maternity care, pregnancy cannot be considered a pre-existing condition under a federal law called the Health Insurance Portability and Accountability Act (HIPAA). Most employer-sponsored group health plans cover maternity care, and many states require them to provide the coverage. Nevertheless, check the benefits to confirm.

Keep in mind, though, the health plan can impose a pre-existing condition exclusion period for other health conditions if you haven't had continual insurance coverage for the last year.

In addition, you may need to wait until the plan's open enrollment period to sign up for coverage. Under HIPAA, people can sign up outside the enrollment period if they lost coverage through another source, such as a job, or after a marriage, birth, adoption or placement for adoption. To qualify for special enrollment, you must sign up within 30 days of a coverage loss or one of these special events.

It doesn't sound like you would qualify for special enrollment under HIPAA. Check with the administrator of your health insurance plan to learn about its rules for special enrollment and to see when you will have the opportunity to sign up.

Although employer-sponsored group policies cannot exclude pregnancy as a pre-existing condition if they cover maternity care, individual insurance plans can exclude pregnancy. Starting in 2014 health reform will prohibit insurers from denying coverage or charging higher premiums for people with pre-existing conditions, including pregnancy. Until then, it's impossible to buy individual health insurance for maternity care if you're already pregnant.

For more, see pregnancy complicates health insurance options.

Last updated: Jun. 15, 2011