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Maternity Insurance
Fighting Pregnancy Discrimination Under federal law, group insurance plans that cover maternity cannot consider pregnancy a pre-existing condition. As a result, if you change group health plans while you're pregnant, the new health insurer cannot deny claims related to your pregnancy. However, because of loopholes, some pregnant women could find they lack insurance coverage for their prenatal care. As a result, it is important for pregnant women to engage in extensive planning.Your Rights Under HIPAA Under the federal law known as HIPAA, group health plans cannot look at pregnancy as being a pre-existing condition. As a result, they cannot exclude coverage for prenatal care or for your baby's delivery, no matter what your employment or health insurance history might be. However, this is only the case if the plan already includes maternity coverage. Also, HIPAA applies primarily to group health plans. This means that, if you move from one individual health plan to another, or from a group plan to an individual plan, you might not receive pregnancy coverage. Or you might find that supplemental pregnancy coverage is too expensive to afford. The Waiting Game You might be forced to sit out a waiting period, even if you are eligible for insurance coverage under HIPAA. For instance, consider a situation in which you're pregnant and have group health insurance, but then switch jobs. Your new health plan might have a standard one-month eligibility period before you can join. Therefore, your pregnancy won't be covered until the plan goes into effect. If you are still in the early stages of your pregnancy, this might not be a problem, since you might be able to pay the out-of-pocket costs for obstetrician visits on your own.
Bridging the Gap In order to bridge the gap between health plans, you might consider enrolling in your former employer's COBRA plan. However, be aware of the fact that employers are not required by law to offer COBRA unless they have at least 20 employees on staff. Also, you'll end up paying quite a bit more in premiums-up to 102 percent of the full premium because of administrative fees. The Individual Insurance Possibility Another option, if you've had at least 18 straight months of group coverage, is to buy a "guarantee issue" individual policy. This means that the insurance company cannot reject you. However, in some states, you might be forced to join a high-risk pool, marked by exorbitant premiums.
In some cases, you might be eligible for insurance help from the government. However, in order to qualify for Medicaid, the government insurance program for the poor, you'll have to meet strict income requirements. You might also qualify for WIC, the Special Supplemental Nutrition Program for Women, Infants, and Children run by the federal government. In order to be eligible for the program, you must be considered a "nutritional risk" by a health professional. |
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