HIPPA and pregnancy as pre-existing condition?

[mum2sarah]

So I just found out I am pregnant, and my current situation is that I am covered by group health insurance as a graduate student at the U of Pittsburgh, and so is my partner.  I will be done with grad school right around the time I'm due with the baby.  We were talking about getting married asap and getting me switched to be covered as his spouse through our insurance just to be on the safe side and be certain I would stay covered throughout the pregnancy and birth.  However, I'm a little worried about the possibility that the pregnancy could be considered a pre-existing condition.  I have been looking into HIPPA portability regulations and keep seeing that if you change group health plans they cannot consider pregnancy a pre-existing condition, but what if you change statuses within the *same* group health plan??   In other words, I wouldn't be switching from one group health plan to another, but switching within the same group plan from being covered as a grad student to being covered as the spouse of a grad student.  I can find no information about this, and with the university on winter break, I can't even go to the benefits office and ask them (also I'm afraid that if I tell them I'm pregnant then it would be too late to claim I didn't know I was pregnant yet).  Anyone understand HIPPA and/or could point me to an actual link of the exact wording of the law so I could interpret it?  All I can find are FAQs and summaries of the law...

[Jenne]

*I* believe that most group health plans don't have pre-existing condition exclusions. Do you have a copy of your insurance policy? It should say on there. If not, call the insurance company and ask if there is a waiting period with the plan.

Congratulations!
Jenne

[tracymom1]

Pregnancy cannot be considered a pre-existing condition, but there can be a waiting period for maternity coverage - even if you are just switching policies under the same plan.  I had Blue Cross/Blue Shield through my employer and when I left that job I called them and said that I wanted to buy the exact same coverage for my family.  At that time I was informed that there would be a 1 year waiting period for maternity coverage even though I had been with them for YEARS.  Now, this may just be because I went from group to individual, but I just thought I would throw it out there for you to check.  Good luck and congrats!!

[gemasita]

Yeah, I did BCBS as an individual one time and was told if I got the maternity coverage, there would be a 1-year waiting period so obviously, if I was already pregnant, nothing would be covered.  With DH's work though, I asked them what would happen if I was pregnant when I switched to his insurance and they said I would be covered.  They actually acted like I was a little crazy for asking.  I think the PP is right that with a group plan, it is probably not an issue but with an individual plan, it might be.  I think it would be ok to just ask asap - you can ask about it hypothetically.

[mum2sarah]

Thanks for the responses!  I do know there are some loopholes to HIPPA, which is why I was concerned.  But I think they are mainly if you go from having group to individual or vice versa, or if you go from having no insurance to being covered by group insurance.  I think those are the situations where they might be able to apply a waiting period.  I was just concerned that I couldn't find any information about changing statuses within the same group coverage, and that maybe there's a similar loophole.  I read my insurance booklet, and saw a list of various exclusions, but it doesn't even list pre-existing conditions at all, so I wasn't sure if maybe the booklet they gave me was just a summary and not the full detailed version.  Perhaps pre-existing conditions are listed on some other document???  Or maybe they just don't have any...

As a sidenote, I'm torn about where to have this baby.  I'd really like another homebirth (which wouldn't be covered by insurance anyhow), but not sure we can afford it this time.  Plus, I know this sounds stupid, but we really want to find out the sex, since we're really hoping for a boy this time, and that wouldn't be an option if I went with a homebirth midwife.  But I know I don't want another hospital birth like I had with my first, so we're thinking of going with a practice of midwives that delivers in the only freestanding birth center in our area.  I feel like it might be the best compromise, and it's covered by insurance.  Thus the motivation behind the question...

[jshannyn519]

I used to work for a health plan and HIPAA prevents group health plans from considering pregnancy as a pre-existing condition. It doesn't matter if you're switching from your group plan to your spouse's group plan, your pregnancy is still covered under whatever the plan coverage is.

As for where to birth... My insurance only covers Certified Nurse Midwives, and none of them practice at freestanding birth centers in my area, not even up to an hour away. So even though I would LOVE a homebirth, I can't afford it and my insurance will only cover a hospital birth. I'm seeing a group of midwives (CNMs) and I'll be doing a hospital birth. Unless, of course, I "accidentally" give birth in my closet at home by myself. :)

My advice is to do your research and meet the various midwives and follow your gut. You'll know what feels right for you and your family.

[LaurenAnanas]

Originally Posted by mum2sarah 

As a sidenote, I'm torn about where to have this baby.  I'd really like another homebirth (which wouldn't be covered by insurance anyhow), but not sure we can afford it this time.  Plus, I know this sounds stupid, but we really want to find out the sex, since we're really hoping for a boy this time, and that wouldn't be an option if I went with a homebirth midwife.  But I know I don't want another hospital birth like I had with my first, so we're thinking of going with a practice of midwives that delivers in the only freestanding birth center in our area.  I feel like it might be the best compromise, and it's covered by insurance.  Thus the motivation behind the question...

My unlicensed CPM was able to order an ultrasound at my request. The local licensed CNMs who do home birth can also order ultrasounds. While my homebirth is only covered as out-of-network (that is, only partially covered), the ultrasound was 100% covered because the ultrasound/radiology practice is a preferred provider. So don't let that sway you- ask what your local midwives can do!
 

[Stayseeliz]

I was in grad school when I got pregnant with my oldest and I switched from an individual BCBS plan to a group plan with the school and everything was fine. Also look into medicaid if you need it. The income limits are very high. Good luck!

[mclisa]

Every insurance can be different.  Most of the time you get burned for pre-existing conditions if you lacked health insurance prior to getting into a new plan.  Since you are covered with insurance now and don't let it lapse, you should be just fine.