Kids and Health Care: If You're Pregnant
Many people choose their kid's first pediatrician based on the advice of the doctors on hand (or close by) when the baby is born. While there's nothing wrong with this strategy, it doesn't allow you to cast the widest net in the search for a pediatrician. It's better to start looking before the baby is born.
Of course, pregnancy is a hard time for many things, including changing health plans -- should you decide that's necessary to get the best care for your child.
But pregnant women don't have to lose any sleep...at least not for this reason. Even they have some flexibility in dealing with health insurance. In some situations, pregnancy can be considered a pre-existing condition that limits your ability to change insurance; but there are some loopholes here.
Federal law bars group health insurance plans that cover maternity from considering pregnancy a preexisting condition. This means that if you change group health plans while you're pregnant, your new group health insurer (as long as it covers maternity) can't deny claims related to your pregnancy. But a variety of loopholes means pregnant women could still lack insurance coverage for their prenatal care if they don't do some careful planning.
Under the Kennedy-Kassebaum Act (which, as we noted in Chapters 1 and 4 also goes by the acronym HIPAA), group health plans cannot consider pregnancy a pre-existing condition and cannot exclude coverage for prenatal care or your baby's delivery, regardless of your employment or health insurance history, but only if the plan already includes maternity coverage. This holds true whether you are the primary insured or a dependent. So, health plans can't deny you coverage when you switch jobs and switch employer-sponsored group health plans.
According to the HIPAA:
EXCLUSION NOT APPLICABLE TO PREGNANCY. A group health plan, and health insurance issuer offering group health insurance coverage, may not impose any pre-existing condition exclusion relating to pregnancy as a pre-existing condition.
Unfortunately, HIPAA applies mainly to group health plans. So, if you move from one individual health plan to another individual health plan or from a group plan to an individual plan, you might not get pregnancy coverage at all, you might have to sit out a waiting period, or, if you are offered insurance that covers your pregnancy, you might find it's very expensive.
While HIPAA is really the only protection women have against pregnancy being treated as a pre-existing condition, the law doesn't apply to everyone.
Unmarried pregnant women take note: Despite the movement afoot in some communities and businesses to offer coverage to "domestic partners," chances are you won't be added to your boyfriend's group health plan simply because you're having his baby; there's no legal requirement to do so, and it's at the discretion of the employer.
Once the baby is born, however, the unmarried father should be able to easily add the baby to his group health plan, although he might have to own up to his paternity in writing first. And a woman with individual health coverage should have little problem adding her baby to her plan.
