Is Pregnancy Considered a Pre-existing Condition??? - The Colony,TX

Updated on November 10, 2010
L.C. asks from The Colony, TX
16 answers

Hi all,
I hope someone has an answer to this one because it's driving me nuts!! I just found out last week that I'm expecting my second child. We have an appointment next week with the doctor to determine due date, make sure everything is ok, etc. I'm sure it will be fine, but - my concern is actually more of an insurance nature. We have fantastic insurance through my husband's work and that is what I'm on, however, he may be switching jobs during this pregnancy and will be getting new benefits. Does anyone know if you switch insurance companies and or policies will you still be covered or do insurance companies see this as a pre-existing condition and won't cover you?
Anyone know for sure?

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So What Happened?

Wow - never seen more conflicting statements!!! Think I'll just call my doctor's insurance people and get this figured out. Thank you to the Human Resources gals who actually know the rules for your responses. As for the lady who's thoughtful suggestion was for my husband to stick it out - maybe you should keep your opinions to yourself.
Thanks everyone!

More Answers



answers from New York on

Itsacrazylifewith4 is right - as long as there's not a break in coverage that is longer than 63 days the new insurance plan can't exclude your pregnancy as a pre-ex condition. HIPAA is a federal law that became effective in the late 90's that was speciically targeted to address a situation like this. I know this becuase I am a consultant to employers regarding employe benefit plans and have been doing this for many many years.

You will need to show the new insurance company proof that you had coverage before - the old insurance company (or sometimes the former employer) will send you a "certificate of creditable coverage" also called a "HIPAA certificate". It will show how long the coverage has been in place and will list each covered family member by name. When you get that from the old company you send it to the new insurance company.

Many times the Human Resources departments at both companies can help speed the process by requesting it right away upon your husband's leaving the old employer and getting it submitted to the new company right away.

Finally - the last thing to consdier - if your doctor is now in your network and he's not in the network at the new company you can request a "transition of care" from the new insurance company. They don't have to offer it, and if you're still in the first trimester they don't usually approve it - but it's worth a try. WIth a transition of care the new insurance company calls your doctor who's not in their network and asks if the MD would accept from the insruance company, the same amount they would pay to their in-network MDs. If the doctor accepts, then the new insurance company would treat the doctor and the claims as if they were in-network. Of course, the best option is if your doctor is in both networks.

Anyway - congratulations on this new little blessing and stay well!

2 moms found this helpful


answers from Chicago on

It can be. But under HIPPAA (sp?), as long as group coverage does not lapse more than 63 days, they have to cover. Make sure he gets a certificate of coverage from your current insurance when it changes so you have proof he had group coverage.

2 moms found this helpful


answers from Dallas on

Pregnancy can NOT be considered pre-existing if you don't have more than a 63 day lapse in coverage. This is federal law. If you go from one group plan to another this will be fine, and the pregnancy will be covered. My husband is currently an HR Director, and I worked as a Benefits Specialist until I quit to stay home with my children. Congrats on your pregnancy!

1 mom found this helpful


answers from Dallas on

Most of the time you are fine as long as you don't let your insurance lapse. Usually the pre-existing condition is for someone who finds out they have a heart condition or something and then goes and gets insurance because they are going to incur lost of medical expenses. If you switch insurances due to a new employer or circumstances of that nature I think you should be fine. I would just be careful not to allow time between insurance companies, don't let it lapse at any point.

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answers from New York on

As long as your dr. is on your new plan, it shouldn't be a problem.

You should call your provider (current and potential) as soon as you can and ask questions. Before your hubby takes the job, ask for a medical benefits package and start to make calls. In my professional experience in HR, I've found that if your doctor is not on your new plan, you will have to switch doctors as long as you are not in your 3rd trimester. Once you enter your 3rd trimester, you will not be required to change doctors and your current plan will pick up the cost. I hope that makes sense.

You can talk to the billing person at your OB/GYN as well. They will have lots of answers for you.

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answers from Dallas on

Of course you would need to check with the individual insurance company, but I believe if you were covered by insurance when you got pregnant, the new plan would have to cover you. That being said, many companies have a 30-60 day waiting period before they insure new hires. If that is the case, you need to do COBRA for the interim so that you don't have a lapse in coverage. I think if you had NO insurance before and hubby got hired it might be considered preexisting and it wouldn't be covered, but as long as there wasn't a lapse you are ok. Of course, that's assuming the new company allows for a family plan on their insurance too. Just ask and if the person hiring hubby is unsure, ask to speak with someone in HR before you get rid of your other coverage.



answers from Topeka on

I would be sure to get a "Creditable Coverage Letter"this will protect you from being turned down due to pregnancy



answers from Phoenix on

From my personal experience, YES, unfortunately, pregnancy IS considered a pre-existing medical condition for many, but not all insurance companies.

Some new companies will only take you if you can prove that you kept all standard pre-natal appts and followed prescribed prental care. They will claim it is too much of a risk if you did not seek pre natal care.

I had this predicament long ago with my first baby. I literally got pregnant 2 days after my husband's new insurance went into effect. Well, I should rephrase that...we had sex OCT 17, baby came July 15th and I had to prove to the insurance companies that I had been having normal menstrual cycles was way too much personal information to provide....b/c point in fact I had had a miscarriage before that and no period, then pregnant. And we had moved...I learned then just what a business our insurance companies really are....they are NOT there to care and protect you....they are there to protect the premiums they collect.


answers from Dover on

Pregnancy is considered pre-existing if you are not already covered for it. If you are currently covered and change jobs/policies/companies, then you are covered.



answers from Chicago on

Depends on the coverage. Mine does not consider it preexisting, but many do.



answers from New York on

I think the best thing to do is call the new insurance company. Is there any way to carry over the previous benefits without paying a huge amount out of pocket?



answers from Atlanta on

Yep, it's a pre-existing condition and if you want to continue coverage for your pregnancy, you'll most likely have to do COBRA until after his new benefits kick in. Once that happens, you can switch over and put the baby on his new insurance as well. This happened to us with our second pregnancy, and it sucks because COBRA is a fortune! You should call the new insurance company and ask what their specific policy is regarding pregnancy as a pre-existing condition. If your husband's new job has a waiting period -as most do-for the benefits to kick in, then that's one of those loopholes where you get screwed. Many companies have a 30-90 day probationary period for new employees before their benefits kick in. When your husband leaves his current job and moves to his new job, you'll have to use COBRA to be covered for that probationary period in order for the HIPAA rule to kick in regarding continuous maternity coverage. If you don't, then they can treat it as a pre-existing condition and not cover your pregnancy at all.



answers from Miami on

I believe every insurance company will have their own policy concerning pregnancy. When my husband added me to his insurance before we decided to have children, pregnancy was considered a pre -existing condition and we could not get pregnant until the insurance was established or my "condition" would not be covered.



answers from Boston on

YES, it can be I suggest your husband try to tough it out or find out ahead of time what insurance he will be offered and contact them to find out their policy on it.

Sorry L. but maybe you should also keep your opinions to yourself. This is a public forum and you asked for advice and that is mine either speak to the insurance he will have at his new job or should stay at his current one. Its not like pregnancy last a life time. I found out I was pregnant with my second child before my insurance at my new job kicked in and it was not covered because it was a preexisting condition if I had known that I wouldn't be covered I would have rather stayed at my old job then gotten stuck with a huge hospital bill that we are still paying off!!!!!!!



answers from Dallas on

Congrats on baby number 2!!!

Pregnancy in this case would be considered pre-existing. BUT if you are switching to a group plan, like through your husbands work, they have to take you and you will be covered. If you are on an individual plan, they won't take you. Texas is a great place in where individual policies don't cover ANY prenatal or postnatal needs.


answers from Davenport on

As long as you have group insurance coverage when a "condition" is "discovered" then it is usually not considered a preexisting condition. Also, federal law prevents pregnancy from being considered a preexisting condition but only if you have group coverage and move to another group, not individual insurance.

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