Can My Sister-in-law Be Denied for Maternity on a Group Plan?

[popeye35]

Okay, so all I sell is individual health, so I know she would for sure be declined for individual. Her situation is unique. She is a public school teacher in Texas currently so she has group coverage. The thing is that technically because of dowsizing of teachers she is being let go in June. But the principal has told her that she will be re-hired because a few other teachers are going to resign. She is 1 month pregnant right now. She will have to re-sign up for benefits in August because she will be like a new hire because they are technically not renewing her contract, but rather letting her go and then re-hiring her.

So can she get maternity coverage, or will they exclude it because she is already pregnant?

Second question, will the same thing apply to her disability insurance?

 

[DS4]

HIPAA provides that employer group health plans can not impose a PCE (Preexisting Condition Exclusion) for pregnancy.
Someone else can answer the second part of your question RE: DI

 

[GreenSky]

HIPAA provides that employer group health plans can not impose a PCE (Preexisting Condition Exclusion) for pregnancy.
Someone else can answer the second part of your question RE: DI

I understood that this only applied to HMO plans and not to PPO plans. I'm not a group health expert so please confirm that maternity is covered without pre-ex or waiting periods.

Rick

 

[popeye35]

I understood that this only applied to HMO plans and not to PPO plans. I'm not a group health expert so please confirm that maternity is covered without pre-ex or waiting periods.

Rick

Thanks for the help so far. It seems as though for the health she can't be excluded. They are kinda trying to get a definite answer before August when she re-enrolls so that they know what to plan for.

Maybe someone can give a definite on the health and on the DI. I do appriciate your help Green and DS4

 

[theinsuranceman]

Why don't you call the insurance co. instead of trusting this forum?

 

[popeye35]

Why don't you call the insurance co. instead of trusting this forum?

That is a good idea. I think he's (my brother) worried about telling them that she is pregnant, but they are gonna find out anyways when she has the baby, so I will tell him just to call the insurance company. People get worried and weird about calling an insurance company and discussing stuff like that because most people feel like health insurance companies are always going to try not to cover things and that they are always going to try to screw them over.

Heck, I sell health insurance (although I mostly sell p&c) and I usually feel like health companies will try to screw me over.

 

[scagnt83]

That is a good idea. I think he's (my brother) worried about telling them that she is pregnant, but they are gonna find out anyways when she has the baby, so I will tell him just to call the insurance company. People get worried and weird about calling an insurance company and discussing stuff like that because most people feel like health insurance companies are always going to try not to cover things and that they are always going to try to screw them over.

Heck, I sell health insurance (although I mostly sell p&c) and I usually feel like health companies will try to screw me over.

Like you said, they insurance company will find out eventually (has she not gone to the doctor yet???)

And if they try to hide any health conditions when trying to get a new policy their claim could very well be denied.
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COBRA is also an option to continue coverage for her, this might help her regain coverage again as a full time employee.
But im not a group health expert, so im sure someone here knows better than I do..

 

[DS4]

I understood that this only applied to HMO plans and not to PPO plans. I'm not a group health expert so please confirm that maternity is covered without pre-ex or waiting periods.

Rick

HIPAA, with respect to "employer" group health plans, applies to HMO, PPO, etc,
Frequently Asked Questions about Portability of Health Coverage and HIPAA

 

[GreenSky]

Thanks for the link. So if someone get's knocked up, they could simply get a job at Starbucks and all the maternity costs are covered from day one.

Good to see that the govt believes insurance covers unforseen expenses.

Rick

 

[arnguy]

Go to www.disabilityinsuranceforums.com. I am sure one of the DI experts on there can answer your question.