Is pregnancy considered a pre-existing condition for STD insurance?

[swalsh411]

What is the name of your state (only U.S. law)? PA

My wife has been enrolled in her employer's STD plan for 5 years. They are switching providers this year with an effective date of Feb 1. In the FAQ they sent out it says they will not cover pre-existing conditions for 12 months. Baby is due late May. Can they deny to pay benefits or is that not considered a pre-existing condition? If they won't pay, that is outrageously unfair. She has been paying through payroll deduction for years, and now they have switched providers and the new one won't pay through no fault of her own. I am hoping that there is a specific exclusion for pregnancy. She has reachd out to her HR department but they aren't very responsive, and the insurance provider won't give us any information other than "talk to your HR department".

 

[LdiJ]

What is the name of your state (only U.S. law)? PA

My wife has been enrolled in her employer's STD plan for 5 years. They are switching providers this year with an effective date of Feb 1. In the FAQ they sent out it says they will not cover pre-existing conditions for 12 months. Baby is due late May. Can they deny to pay benefits or is that not considered a pre-existing condition? If they won't pay, that is outrageously unfair. She has been paying through payroll deduction for years, and now they have switched providers and the new one won't pay through no fault of her own. I am hoping that there is a specific exclusion for pregnancy. She has reachd out to her HR department but they aren't very responsive, and the insurance provider won't give us any information other than "talk to your HR department".

I didn't think that it was possible under the ACA for any policy to refuse to cover pre-existing conditions at all.

 

[FlyingRon]

I assume she means SHORT TERM DISABILITY. ACA only covers health insurance which STD is not. Anyhow most STD policies don't have a preexisting condition exclusion and frequently this is waived on a corporate cutover anyhow. You need to check if the policy specifically covers or disclaims pregnancy (most I think do cover it).

Unless she has Sexually Transmitted Disease insurance. My wife smacks me every time I describe pregnancy as a sexually transmitted disease.

 

[swalsh411]

I just answered my own question. I called the carrier and there is a "transfer provison" (they also called it a transfer credit) which says if you had prior coverage they will not apply the 12 - month pre-existing condition rule. Phew!

 

[cbg]

But for what it's worth, the prohibition against pre-ex under the ACA relates to health insurance. It does not apply to short term disability.

There is no automatic exclusion for pregnancy, the way there was under HIPAA for health plans until the ACA kicked in. But most (not all, but most) plans do handle it the way this one turned out to handle it - by grandfathering a pregnancy during the transition period.

 

[OHRoadwarrior]

Technically, pregnancy is a parasitic infection.

I assume she means SHORT TERM DISABILITY. ACA only covers health insurance which STD is not. Anyhow most STD policies don't have a preexisting condition exclusion and frequently this is waived on a corporate cutover anyhow. You need to check if the policy specifically covers or disclaims pregnancy (most I think do cover it).

Unless she has Sexually Transmitted Disease insurance. My wife smacks me every time I describe pregnancy as a sexually transmitted disease.