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Ask the Health Insurance Expert

We just found out my fiancee is pregnant; we think she's about three weeks along. She is a student teacher now but will start a full-time teaching job in August with a district that offers full medical insurance coverage. How will we afford the pregnancy until then? I make too much money for her to qualify for any state assistance for medical coverage after we get married in June. Once she starts her new teaching job, will her insurance coverage exclude the pregnancy as a pre-existing condition?

Under HIPAA -- the Health Insurance Portability and Accountability Act -- employer-sponsored group health insurance plans cannot exclude pregnancy as a pre-existing condition, even if the woman had no previous health insurance coverage. (The health plan can exclude other pre-existing conditions for up to 12 months if the enrollee did not maintain credible health coverage for the last year.)

Keep in mind, though, the health plan may have a waiting period before any new employees and their dependents can enroll. Your fiancee will have to sit out that waiting period, but once she is eligible to join the plan, the pregnancy should be covered.

The U.S. Department of Labor website provides details on how HIPAA rules apply in various circumstances.

Before she starts her new job and after you are married, you can enroll her on your health plan at work if you have health insurance through your employer and the coverage is extended to dependents. Talk to your employer's human resources department for details.

If that option is not available, your fiancee might want to consider the Pre-Existing Condition Insurance Plan, a new government insurance program created under the Patient Protection and Affordable Care Act, the federal health care reform law. Eligibility is not based on income. To qualify, an enrollee must have a pre-existing condition and must have been without health insurance for at least six months. Premiums vary by state, but none of the PCIP plans charges a higher premium based on the applicant's condition. You can find more information about the plan in your state at PCIP.gov.

For more, see Think you're locked out of affordable health insurance? Try PCIPs.

Last updated: Apr. 18, 2012