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Is pregnancy a qualifying event?

Questions about Insurance and Pregnancy

A few questions came up recently regarding pregnancy: Is pregnancy a qualifying event? Can an expectant mother be added to a group health plan as a dependent when she finds out about the pregnancy? What if she isn't married to the father? Qualifying events can be a bit tricky and this is something I deal with almost every day.

Here is how this works:

  1. Pregnancy is not considered a qualifying event.
  2. The only time an employee can add a non-spouse domestic partner to a group plan is at open enrollment and that is only if the plan allows for it.
  3. The father cannot use his insurance policy to file any claims for the uninsured mother. If they are married, though, then he can use money from his Health Savings Account to pay her medical bills (if he has an HSA).
  4. For the father to add the mother to the health insurance plan, he would have to wait until his plan's open enrollment.  
  5. Once the baby is born, the father can add the baby to his plan, effective on the date of birth.

Also, it's important to note that due to HIPAA, pregnancy cannot be considered a pre-existing condition. So, if open enrollment comes up before the baby is born, the wife can be added to the plan without fear of a pre-existing condition exclusion of her pregnancy expenses. The same would apply for a non-spouse in the event that the plan allows domestic partners. This means that all maternity costs would be covered by the policy. Bear in mind that you would still be responsible for any deductibles, coinsurance, and copays.

If you have any follow up questions to this, just leave them in the comments below.

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