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Is pregnancy considered a pre-existing condition?

A pre-existing condition is any health condition you had and were aware of before the effective date of a health insurance policy. So yes, pregnancy is a pre-existing condition if you became pregnant before enrolling in a health plan. Your ability to find coverage for your pregnancy depends on whether you enroll in a group health insurance plan or you're seeking coverage through an individual health insurance policy.

Under employer-sponsored group health plans, pre-existing conditions are covered when you enroll, as long as you had health insurance for the prior 12 months without a coverage gap of 63 days or more. If there was a coverage gap, then pre-existing condition exclusions can apply to your group health plan. A group health plan can deny coverage for a pre-existing condition for a certain amount of time, typically 12 months, then the condition must be covered.

For individual policies, health insurance companies can exclude pre-existing conditions. That will change in 2014 when, under the new health care reform law, insurers will not be able to discriminate based on pre-existing conditions. But until then, it's virtually impossible to find maternity coverage through an individual health insurance plan if you are already pregnant.

If you need health insurance and can't get it through work or your spouse's employer, check to see if you're eligible for a state high-risk insurance plan or the new Pre-existing Condition Insurance Plan. These plans covers adults who can't find health insurance due to a pre-existing condition. The U.S. Department of Health and Human Services has set up a centralized website for consumers to learn more about the Pre-existing Condition Insurance Plan.

For more, see What is a pre-existing condition, exactly?

Last updated: Mar. 14, 2011