Health insurance coverage

[Lynn32203]

What is the name of your state? Indiana

My husband recently got hired in May for a new job. He was told that his health benefits (a group plan) would begin June 1. Seeing as how he didn't really start until June 6th or so, he has just recently turned in the insurance application and such, and we haven't gotten formal paperwork with insurance cards and such back yet, but the insurance is supposed to be retroactive. I just recently (two days ago) found out I was pregnant. The health plan we will be enrolled in DOES cover maternity, but I have no idea if they are required to cover it because the "conception window" is so close to when the coverage began, maybe if it were May 31st they would consider it a pre-existing condition? I don't know if there is any way of proving an exact date (whether it was before June 1 or not). I believe it was in June, but I don't know what insurance companies do in this situation and if there are any legal issues about what they have to, or don't have to do. Thanks in advance for any info anyone can provide! Hope this was clear enough, and please let me know if you need more information!

[cbg]

Did your husband have previous group coverage with a former employer? If so, when did end?

[Lynn32203]

No, we have been on individual insurance. I do know that they would be required to cover it had we been on a group plan for a certain amount of time, and that they are NOT required to pay if I was pregnant before the enrollment date. But that's the tough part of it...as far as I know there is no waiting period for benefits, and our sheet that describes coverage says that pregnancy is not considered a pre-existing condition, and it says nothing about "only if you had a group plan before" or anything like that. Its so confusing! Any guesses as to what might happen?

[cbg]

I think you're worrying ahead of your data. Pregnancy is not something like a car accident. You KNOW precisely what moment you had the car accident; that's not necessarily the case with a pregnancy.

I'm not sure what you mean by a waiting period for benefits. Are you thinking that perhaps there is a clause that they won't pay for pregnancy unless you have been on the plan for x amount of time? If so, relax. It would be illegal for them to have such a provision for pregnancy unless they also had it for other conditions, and that would pretty much wipe out the idea behind health insurance in the first place. Unless the plan specifically says you cannot use the plan until you have been covered by the plan for x amount of time, you can safely assume that all benefits are available at 12:01 a.m. on the first day that the coverage is effective.

If that's not what you mean, please clarify.

[Lynn32203]

No, I guess that's what I meant. You just stated it much more clearly! Thanks for that I guess I just didn't know what will happen when I do get to the doctor, and if the health insurance company would/could investigate or something and potentially not cover me since I found out I was pregnant a week after coverage was supposed to start but I couldve technically conceived before coverage began and we don't know if it was technically before or after.

[cbg]

Because pregnancy is a protected condition, it's quite unlikely that a company would try to call it a pre-ex condition, especially when we're talking about a matter of days. It would not be worth their while to try to deny a pregnancy claim because you *might* have gotten pregnancy on May 31 instead of June 1.

Besides, a pre-existing clause is predicated on the date you first had medical treatment for a condition, not the date that the condition may have first existed.

As long as you didn't see a doctor for the pregnancy prior to the first date of coverage, pre-ex will simply not be a factor.

Don't worry and congratulations on the baby!

[Lynn32203]

Thank you so much! I really appreciate it!