by eatmoredesserts » Mon Jan 25, 2010 08:55 pm
Hello, I currently have an individual health plan but recently discovered it does not cover maternity. I am not pregnant, but am going through IVF treatment. I am getting turned down by the big co's because of this. I work for a very small company, just my boss and I, and he's offered to start up a group plan. If our group plan is accepted, will I be "guaranteed" maternity coverage even though I admit on the application I'm going through IVF? Other than that I have no health issues. My boss is 64, but doesn't have major issues. Thank you!
Sorry - re-posting here because my last one went under auto insurance.
Sorry - re-posting here because my last one went under auto insurance.
Posted: Tue Jan 26, 2010 04:55 am Post Subject:
If it's a group plan there is no underwriting so there would be no admitting to undergoing IVF in the application process.
The guarantee will be up to the policy, you'll want one with decent maternity coverage. Assuming that it has it, and you are enrolled once the plan is accepted (don't see a lot of reason why it wouldn't be) you'll have coverage.
Posted: Tue Jan 26, 2010 04:56 pm Post Subject:
Thank you BNTRS! So on the employee application, where you're supposed to list any prescription meds taken within the last 6 months I should just leave it blank? That's the part I was referring to admitting I was going through IVF; it asks what meds and the reason. Thanks, Kelly
Posted: Wed Feb 03, 2010 11:29 am Post Subject: Employee application
Even group plans have general waiting period and pre-existing term exclusion period ranging from 3-12 months. So you can include them in your employee application.
Posted: Wed Feb 03, 2010 08:04 pm Post Subject:
Even group plans have general waiting period and pre-existing term exclusion period ranging from 3-12 months. So you can include them in your employee application.
Group plans RARELY allow exclusionary periods for pre-existing conditions (pre-x), and that typically occurs only for late enrollees. I don't know of any state that will allow "on-time" enrollees to be whacked with pre-x limitations. Now, I'll be the first to admit that I don't know the laws in every state, but in the 30+ we work in, none of them allow pre-x for group enrollees that enroll within their open enrollment period.
When considering issuing the policy in the first place, the insurer will definitely worry about pre-x in terms of issuing it initially. Once issued, the state rules take over regarding pre-x.
As to whether you need to tell them about your IVF treatments? Yes, you have to tell them with the initial census and enrollment process. Failure to disclose a material fact in the application can be cause for a whole mess of future problems.
Finally, please be aware that not all states mandate fertility treatments be covered under maternity coverage...it depends on the state and not many of them require this to be covered.
InsTeacher 8)
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