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Pregnancy As A “Pre-Existing Condition”

Women who own individual healthcare policies, please take note. Should you become pregnant in the future, your individual healthcare policy might not cover your pregnancy.

A recent article in the Los Angeles Times by Michelle Andrews was revealing. Andrews described the plight of a North Carolina biology teacher who subsequently left teaching after the birth of her twins. She became a small business owner and was covered under individual health insurance policies. However, when she became pregnant again, she had a rude awakening. Despite paying an insurance premium of $400 per month, her pregnancy wasn’t covered unless she had paid for a special rider, prior to becoming pregnant. Since half of all pregnancies are “unplanned” how can you pay for coverage six months in advance of an unplanned event?

On October 12, 2010, the Committee on Energy and Commerce produced a dismal report that revealed a total disregard and absence of concern for pregnant women and their unborn babies by the insurance industry. The Committee’s chairmen, Congressmen Henry Waxman and Bart Stupak revealed the following:

  1. Aetna, Humana, United Health Group and WellPoint, the four largest for-profit health insurance companies each listed pregnancy as a condition that would be automatically denied for individual healthcare plans.
  2. Health insurance companies often exclude maternity care from individual plans but also exclude maternity coverage from health plans they offer to individuals who are not pregnant at that time;
  3. In California, 9 of the 14 health plans offer no benefits for pregnancy-related medical claims.
  4. Insurance companies severely limit the benefits they provide under maternity riders. After paying for expensive riders with extremely high deductibles, an insured woman will receive no more than $6,000 despite the possibility of her hospital charges costing much more.
  5. Health insurance executives have developed business plans designed to reduce coverage of maternity expenses. Some of these executives were quoted as saying “we have analyzed the economics of our maternity rider and will stop offering except where required by state statutes.”

What does all of this mean for pregnant women? If you receive insurance through an employer who has more than 15 employees, you will receive adequate maternity benefits, thanks to the Pregnancy Discrimination Act of 1987. However, if your company has less than 15 employees or you are seeking an individual health plan, buyer beware. The saving grace is the Affordable Care Act that was enacted on March 23, 2010. Effective January 1, 2014, pregnancy will no longer be considered a pre-existing condition and maternity care will be an “essential health benefit.”

January 1, 2014. We await your arrival with bated breath.

*This blog post was originally published at Dr. Linda Burke-Galloway*


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