Client with NGF Plan is Pregnant

toddoxley

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Arizona client calls this morning with a non-grandfathered individual plan and states she is pregnant and due 8-18-14. Does the fact that she is pregnant allow her a SEP to enroll into a ACA plan to cover the pregnancy ?
 
Arizona client calls this morning with a non-grandfathered individual plan and states she is pregnant and due 8-18-14. Does the fact that she is pregnant allow her a SEP to enroll into a ACA plan to cover the pregnancy ?

Simply put: nope. Sorry.

The birth may not be all cut and dry either....
 
Will confirm Tim's statement, pregnancy is not a QE.

Birth is, and the child may obtain coverage at the time of birth (within 60 days, etc.) Due to the "coverage household" rules we've heard from CMS, the birth would also allow the parent(s) to obtain or change coverage as applicable. Obviously, this would only cover post-effective-date expenses, meaning pre-natal and delivery would not be covered.

As for the expense of the birth, if her current plan doesn't cover pre-natal/delivery, she's in a tough spot.

Does she qualify for medicaid?
 
Arizona client calls this morning with a non-grandfathered individual plan and states she is pregnant and due 8-18-14. Does the fact that she is pregnant allow her a SEP to enroll into a ACA plan to cover the pregnancy ?

Meritus AZ sells off exchange year round now with no SEP required.
 
If she keeps her insurance thru the pregnancy she can buy a package plan from a local hospital. Google search terms ....blue cross arizona maternity packages.
It is truechoicebenefits.biz/babyontheway.html
 
If this was a concern, she should have picked a new ACA plan and paid the likely additional premiums during open enrollment - she had six months to do this.

Hate to point out the obvious...

Find her another SEP... Read through all of them and ask her if any apply to her, if not well - next time she can be a little more careful of open enrollment deadlines.
 
Messin with moving someone to another plan with pre-ex is scary stuff... I myself wouldn't like to go there. Especially to SEP plan. We moved one pregnant woman who was with assurant group plan to an off exchange Blue Cross plan with a lower deductible during open enrollment but I made sure all of her providers we're in the network first. Because the new plans had new networks
 

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