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Does the HIPAA law apply to me as well?

Health Insurance Forum

May 15, 2007

My individual health insurance began in March and I was already one month pregnant. My plan does cover pregnancy, however my policy says that maternity benefits are only available if the date of conception falls within the covered period. It is clear I conceived before my health insurance began. HIPAA says that no group plan can deny coverage for pregnancy as a pre-existing condition. Does this law apply to me as well?

Zohra, Georgia

Dear Zohra,

No, the federal HIPAA law applies mainly to group health plans. You have an individual health insurance policy that specifically excludes pregnancy when conception occurs before coverage begins, therefore your insurance company will refuse to pay for any medical treatment relating to your pregnancy. Read HIPPA: Your rights to health insurance portability.

At this point in time, no individual health insurer will offer you coverage. Under HIPAA, a group health plan cannot impose a pre-existing condition exclusion on your pregnancy, but you would have to secure a new job with an employer that offers maternity benefits as part of its health insurance benefits package. See Pregnancy complicates health insurance options.

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Disclaimer: We are journalists, not financial planners or insurance brokers. Nothing we say should be interpreted as a recommendation to buy or sell any insurance product, or to provide other financial or legal advice.

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