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Short term disability question

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FarFar

Junior Member
What is the name of your state? Oklahoma

Hello, I've had this Voluntary STD coverage for 3 years now (I pay 100% premium) but my company is changing the insurance provider so we're required to do the enrollment again which I did last week. I just found out that I'm 5-week pregnant today. Will I be covered when I leave for maternity 8 months from now by this new company? or will they consider my pregnancy is a pre-existing condition? Thanks for any help.

Farfar
 


cbg

I'm a Northern Girl
Only the disability carrier can answer that for certain. The laws that prohibit pregnancy from being considered a pre-ex condition on group health insurance do not apply to disability plans.

But speaking from experience, I think it's unlikely. Most of the time, if you have not seen a doctor for any condition (not just pregnancy) at the time of the enrollment, they don't consider it pre-ex, even if the condition existed prior to the beginning of the plan.
 

FarFar

Junior Member
Hi cbg, thank you for responding to my question. Here is what I found written in the plan about the pre-existing conditions: "We will not cover a disability that begins in the first 12 months after the effective date. This applies if the disability results from a pre-existing condition with treatment (or symptoms for which an ordinarily prudent person would seek treatment) within 12 months prior to the effective date." Under the coverages section it says: maternity, alcoholism, and mental conditions are covered in the same manner as any other illness.

Should I assume that they will not deny me benefits later? Or should I come forward now to ask the question directly since the enrollment is still open and I could cancel my enrollment if they said the wouldn't pay my benefits since I was conceived before the begining of the plan? Thanks again.
 

cbg

I'm a Northern Girl
The operative words here are WITH TREATMENT. That means that if you have not been TREATED for a condition within 12 months of the effective date, it's covered. The EXISTANCE of the condition is not a factor. TREATMENT for the condition is.

So if you've seen a doctor for the pregnancy prior to the effective date, you will not be covered. If you haven't, it should be covered, as long as you don't wait beyond the time that "a normally prudent person" would see the doctor for their first pre-natal visit.
 

FarFar

Junior Member
I went to see my OB yesterday for my anual check up, the appointment wasn't made for the pregnancy) and that was when I found out I was 5-week pregnant. The doctor went ahead and sent me over to the lab for the prenatal screening. I guess everything just happens at the wrong time. I don't really know what the effective date for the Voluntary STD is. The regular health insurance package (medical, dental and vision) is effective on July 1st, but since this is a voluntary, I'm not sure if its effective date is also July 1st. It doesn't seem fair for the employees at all, I'm forced to change the insurance carrier. Thanks for your help.
 

cbg

I'm a Northern Girl
Believe me, employers do not change carriers without a reason. It is a royal pain in the rear to do so and it would be MUCH simpler for your employer to leave the old plan in place. If they are changing the disability carrier, it is probably because the rates went WAY up on renewal. Trust me, this is what I do for a living. There is NO WAY your employer decided to change carriers on a whim.

The very strong likelihood is that the effective date is July 1. It would be quite unusual for the STD to have a different effective date than the rest of the benefits.

What I would do in your shoes is talk to someone in HR as to whether or not having the pregnancy caught during a standard OB exam qualifies as "having had treatment" for the condition under this particular policy. It's also POSSIBLE (though I can't guarantee it) that there is some form of grandfathering in place for those who have been continuously covered.
 

FarFar

Junior Member
I'd rather not break the news this early but I might have to talk to the girl in HR about it or I'll go crazy for the rest of my pregnancy which might not be good either.

The company did say that changing the STD insurance carrier would save some money, but it's not really significant in my case anyway ($10 more per month) based on both age and salary. It's really puzzeling to me as why they're chaning the STD carrier but not the other regular health package. They're keeping the carrier for those but changing the benefits. That is why I don't know if the effective date for the STD is the same as other ones. It just seems to me that the STD is just a total separate thing. I might be wrong and I hope I am.

I hope you're right about the "grandfathering in place for those who have been continuously covered". It says in the plan handed out to us though that 12/12 pre-existing limitation applies for all employees, so it kind of tells me that they're not taking continuous coverage into consideration.

I'm caught in the middle!
 

cbg

I'm a Northern Girl
I don't have to be there to answer the question of why they're doing what they're doing. I've seen it many, many times before and quite often been the one who implements the changes.

I'll offer you about a 99.99% guarantee that this following is the case:

ALL benefits renew July 1. When the employer got the renewal packages from the various carriers (which are billed to the employer separately) their rates had gone up significantly. The employer "shopped" the plans (that's an HR term meaning that they got quotes from other companies to see if they could do better) and found that the best deal they could get on the health insurance was to buy a different plan from the same carrier. On the STD insurance, however, they couldn't get an effective deal with the same carrier and in order to get anything like the same benefits without a significant increase in premium, had to go to a different carrier. When you change carriers, you need to complete a new enrollment form. That is a given and a 100% guarantee. NO carrier will accept a new enrollment without their own forms. Since the health insurance carrier is not changing, however, only the benefits, no new enrollment was needed.

If you get 50 HR managers into a room, 49 of them will tell you that they HATE changing benefit plans and they HATE the open enrollment period (which is what you are in right now, when employees are allowed to make changes to their benefits - add/subtract dependents, move from one plan ot an offer if more than one is offered, etc.). The 50th will be one who absolutely loves the benefits part of her job and wishes she didn't have to do any of the rest of the stuff. But for cost purposes - cost to the employer and cost to the employee both - it has to be done.
 

FarFar

Junior Member
OK. I talked to the girl in HR who handles all the insurance matters and she assured me that I would be covered. cbg, you're right, the effective date for the STD is July 1st same as other ones. She also said that the pre-exisiting condtions exclusion wouldn't apply to me either because I have the continuous coverage from the old plan. I feel so much better now. Thanks for all your inputs.
 

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