It is vital that pregnant women receive sufficient health care.
Pregnancy was once considered a preexisting condition by group health insurance companies, but HIPAA, the Health Insurance Portability and Accountability Act of 1996, created federal rules that made health insurance easier for pregnant women, among others, to obtain. The act was intended to help employees receive better health insurance even if they were previously ineligible. Individual insurance plans are not required to provide coverage to a woman who is already pregnant when she joins the plan.
Maternity and Health Insurance
HIPAA only applies to group health insurance plans that provide maternity coverage. If the insurance company does not provide maternity, prenatal or infant insurance to its members, it cannot be required to offer coverage to a pregnant woman enrolling in the plan. Mandatory waiting periods may still apply, so the pregnancy may not be insured for up to 63 days after enrollment is complete.
Pregnancy and Adoption
HIPAA allows employers to look back 6 months on your medical record to determine whether a condition is preexisting, in contrast to previous laws that allowed employers to look at a complete medical history or any portion thereof. Additionally, HIPAA specifically states that pregnancy cannot be listed as a preexisting condition to exclude coverage for pregnant women or their newborn children. The law also applies to adopted children who are enrolled in the insurance plan within 30 days of being adopted.
Insurance Waiting Period
Enrollment in a health insurance plan does not mean immediate coverage for all conditions. Insurance companies are allowed to require the plan to be in effect for as much as 60 days before coverage is available for some conditions. Pregnancy was once excluded under this clause but is now covered under the provisions of HIPAA.
Health Care for Women
Pregnant women who do not have group health insurance can still receive coverage for prenatal care, delivery and postnatal infant care through government-sponsored programs. According to the Centers for Medicaid and Medicare Services, women who qualify for coverage are entitled to immediate coverage, even if they are covered by another insurance plan that specifically excludes pregnancy for reasons other than a preexisting condition.
Post-Natal Care
The Affordable Care Act of 2010 increased the period that children can remain on their parents' health insurance to the age of 26, but it did not extend coverage to children of covered dependents in the same manner. What this means is that although a dependent daughter's pregnancy may be covered under the age extension, the insurance company is not obligated to extend coverage to the newborn child. In this situation, the mother could continue her health insurance coverage and seek coverage for her baby under Medicaid or other state sponsored plans.
Tags: group health, group health insurance, health insurance, insurance plan, preexisting condition, coverage pregnant
