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Maternity Insurance No Waiting Period Question & Answers

2014 March 9
by Sarah Fields

William asks…

Does maternity rider for individual health care plans and group plans work differently?

Say if the waiting period is 10 months and you conceive 4 months from the start of maternity rider. Does this mean that the insurance company will foot the bill for delivery but not the pre-natal care , ultrasounds etc ? If you are a part of an employer’s group plan with maternity benefits/maternity rider, does this waiting period work differently?

Sarah Fields answers:

It is a federal mandate that pregnancy cannot be considered as a pre-existing condition. It is under the HIPAA laws and more information can be found here: http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html

Individual health insurance may be different between plans. Some plans word the maternity waiting period as X number of months for conception while others word it as X number of months for delivery.

Chris asks…

How long after I buy my maternity insurance can I conceive?

Sorry in advanced for being so long winded…
When applying for health insurance with maternity coverage with BCBSFL it says two things. The first being “Maternity Coverage must be in effect 30 days prior to conception.” and the second being “I agree to allow Blue Cross and Blue Shield of Florida, Inc. to select my coverage effective date as the first available effective date that occurs on or after the underwriting decision date. Available dates are the 1st and 15th of each month.” there is an option to say no to the second statement but the earliest date is the 1st of February. The thing is that my fiance and I are getting married on March 2 and would like to conceive during the honeymoon. My question is: 1) if there is a waiting period and we do conceive in that waiting period would we still be covered for everything after the insurance kicks in and just pay for everything before that or will the coverage just be voided and considered a ‘pre-existing’ condition? 2) if we decided to just wait for the coverage to kick in, how long would it be until we could conceive?

Sarah Fields answers:

1. There is a waiting period. If you conceive during the waiting period, then nothing related to being the first pregnancy or giving birth to the child or children conceived during the waiting would be covered ever, even after the waiting period. The coverage would not be voided completely; you would still be covered for unrelated medical conditions and for future pregnancies. But you would have to pay for everything for this pregnancy yourself, with your own money, because you would not have any insurance coverage for it.

2. You have to wait 30 days after the “effective date” of your coverage. If you let them select the effective date, then it will be 0 to 16 days after they make the underwriting decision, which means that you will have to wait a total of 30 to 46 days after they make the underwriting decision. If you select the effective date, then you have to wait either the same amount of time or until 30 days after the effective date that you select, whichever is longer.

If they make the underwriting decision before the end of this month (January), then the earliest you can have for your “effective date” (when you start being covered for things other than pregnancy) is February 1, and you have to wait until 30 days after that, which would be March 2. If they make the underwriting decision during the first 15 days of February, then the the earliest you can have for the effective date is February 15, so you would have to wait until March 17. If they make the decision during February 16-28, then you would have to wait until March 31. Etc.

Ruth asks…

What happens if you get pregnant while waiting for approval from insurance company?

Well I’m not sure yet if I am pregnant… But there is a very good possibility. And we have been careful, for the most part- but sometimes you just can’t help it.

My husband and I decided to switch insurance policies and add maternity coverage. With my policy- there is no 12 month waiting period for maternity coverage to be available. It is effective immediately upon approval. And it doesn’t say anything, ANYWHERE about what happens if you get pregnant while waiting for approval. It only says that the applicant can not be pregnant at the time of application.

Has this happened to anyone?

Sarah Fields answers:

How long does it take for the approval? If it is just a few weeks you will be fine. Usually ob drs wont see you until you are 4 weeks along. If you are in fact pregnant and it may take longer then that to get your approval, I would call the dr’s office that you plan on attending and explain whats going on with your insurance and they should be able to tell you what to do! Good Luck =)

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