What is a pre-existing condition? Why is it a big deal?

I got married in November and joined my husband’s health plan on December 1. I hadn’t had health insurance for almost a year before that. In mid-December, we learned that I am two months pregnant. Since I was pregnant before December, will my husband’s plan refuse to the pre-natal care and labor/delivery?
Lucky in Love

Dear Lucky in Love,
You are indeed very lucky. Your husband’s health plan – if it is a group plan through an employer – will cover your pregnancy. Since you did not have any treatment during the six months before you joined his plan, the pregnancy is not considered a “pre-existing condition”. A “pre-existing condition” is an illness a person has and gets medical care for in the six months before he or she joins a plan.
Even if you had known about the pregnancy and started pre-natal visits, your new plan would have to cover your pregnancy. Pregnancy is one of the few exceptions to the rule.
Your lapse in coverage means that your new plan can refuse to pay for other health problems that you got treated for during that crucial six months. If, for example, you take drugs for high blood pressure or depression, the group plan can refuse to pay for the drugs or visits related to those illnesses.
At least for your pregnancy, you can breathe a sigh of relief, which can be your warm-up for your breathing classes!

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Linda Riddell

About Linda Riddell

A published author and health policy analyst with 25 years’ experience, Linda Riddell's goal is to alleviate the widespread ailment of not knowing what your health plan can do for you.