A pre-existing condition is a condition (physical or mental) that was diagnosed or treated within a certain period of time prior to switching insurance plans. Insurance companies can only place a pre-existing condition limitation on diagnoses or treatments that occurred six months prior to coverage inception. In other words, any condition that was diagnosed or treated within six months prior to switching health insurance plans falls under the pre-existing condition exclusion or limitation.
Once a condition is deemed pre-existing, an insurance company can limit or exclude coverage for the condition for a period of 12 months (18 months for those who enrolled late). Fortunately, the Health Insurance Portability and Accountability Act of 1996 (HIPPA) has clearly defined how insurance companies must respond to pregnancies.
Pregnancies Are Not Pre-Existing Conditions
Although a pregnancy may have occurred prior to enrolling in a health insurance plan, according to HIPPA, insurance companies can not deny, exclude or limit coverage because of it. The wording as listed in the HIPPA outlines, "HIPAA prohibits plans from applying a preexisting condition exclusion to pregnancy, genetic information, and certain children."
Therefore, if you are pregnant and are looking to switch health insurance companies, you may freely shop and select a health insurance plan that works best for you and your family. Keep in mind, however, that although pregnancy is not considered a pre-existing condition, if you have other conditions which fall under the pre-existing condition category, the insurance company may legally apply an exclusion/limitation to that non-pregnancy condition.
No Prior Creditable Insurance
Pregnant women are also excluded from the prior creditable insurance requirement. Health insurance companies will enforce the pre-existing condition exclusion if you cannot prove that you had continuous creditable insurance. Continuous creditable coverage means that health insurance coverage was in place and in force with a gap of no more than 63 days. Health insurance companies require evidence of continuous coverage in the form of a certificate of creditable coverage issued by your prior health insurance plan.
Pregnant women, whether they were previously covered or not, are not subject to the prior creditable insurance requirement.
Continuation of Pre-Natal Care
While pregnant women can switch health insurance carriers without worry of the pregnancy pre-existing condition limitation/exclusion, they should do their homework when it comes to the team of doctors who are treating their pregnancies. Women often become attached to their obstetricians and prefer to have one doctor or a team of doctors treat them from the beginning to the end of the pregnancy. By switching insurance plans, there is a chance that the current doctor may not be a participating physician in the new health insurance plan.
It's best to confirm which health insurance plans your current physician accepts. Doing so will increase the likelihood of finding a plan that will allow you to keep your current medical team for consistent pre-natal care.
Felicia A. Williams - Felicia A. Williams is a full time freelance writer with over 20 years of business writing experience.
