Will pregnancy be a pre-existing condition if I'm moving to the US from a country with national health care?
December 2, 2011 10:15 AM   Subscribe

Is pregnancy a pre-existing condition if you're moving from a country with national health insurance?

Hello! The husband and I feel ready to have a kid -- yay!

Here's the rub. Right now we live in the UK, but we're planning to move to the US before nine months is up. We'd have group health insurance in the US, but if I were pregnant before we left, would I be excluded on pre-existing condition grounds? Right now we obviously don't have insurance in the UK except for the national health service. Would this count? And does it matter what state we move to?

Extensive googling has not come up with answers. All info & advice would be much appreciated!
posted by anonymous to Grab Bag (10 answers total)
Would the insurance be through his employer (or yours), or would it be private-pay? Employer-offered health insurance usually isn't subject to pre-existing condition exclusions, I don't think.
posted by KathrynT at 10:27 AM on December 2, 2011

Group coverage does not usually exclude pre-existing conditions. So if you one of you gets health insurance through your US job, you probably will not have a problem. (In fact, I almost lost my health insurance when I was full term with my first child, and my husband's employer assured me that they could add me to his plan the day my coverage lapsed, with coverage to include labor and delivery.)
posted by robinpME at 10:27 AM on December 2, 2011

"Pre-existing Condition Insurance Plan In Effect

Creates a temporary program to provide health coverage to individuals with pre-existing medical conditions who have been uninsured for at least six months. The plan will be operated by the states or the federal government.

Implementation: Enrollment into the federal plan began July 1, 2010; implementation dates for the state-operated plans vary

Implementation update: The federal government is operating PCIP programs in 23 states and the District of Columbia, while the remaining states are running their own programs. On July 30, HHS released interim rules for the PCIP programs. On November 5, 2010, HHS announced new plan options for 2011 that include lower premiums for the federally administered programs. As of March 2011, 18,000 individuals had enrolled in a PCIP program."

From here, click 2010 and scroll down. The "uninsured for 6 months" thing - I don't know offhand if being insured in another country counts. And from what I've read, these plans are not exactly cheap. Your best bet is that one of you gets group coverage through your U.S. job.

Usual disclaimer: I work for this place, but don't have anything to do with the writing or creation of stuff like this, except to fix links and stuff if they're broken.
posted by rtha at 10:37 AM on December 2, 2011

I'm not sure this can be answered with the amount of information that the OP has provided. The crux of the question, as I read it, is this:

We'd have group health insurance in the US,

How do you know this? That is to say, are you moving back here with a job that provides (group) health insurance in place? That's the major way to get group insurance here; if you and your husband are coming back without job(s) in place, then you'll be shopping for individual (family) plans.

If you're indeed getting health insurance through a job, there are issues of HIPAA involved; one of the requirements is that, in order for pre-existing conditions not to count against you when going on to a group plan, you must show that you have not had a lapse in insurance coverage of more than 63 days. You traditionally show this to a new insurer by something called a certificate of creditable coverage, which is basically a form letter that a previous insurer will generate to say that you were indeed covered and what your last date of coverage is. The NHS in the UK, however, almost certainly doesn't issue this sort of document for American insurers; however, you could contact the new insurer and ask what an appropriate substitution might be (such as an NHS registration card?).

If you're not coming to the U.S. with a job in place, then I think you're going to have to think about getting individual insurance, so that you won't have a 63-day lapse by the time you do get onto an employer's group plan. And I believe individual insurance plans can vary quite a bit in terms of consideration of pregnancy as a pre-existing condition.
posted by scody at 10:40 AM on December 2, 2011

Nthing that group coverage includes pre-existing conditions, however, there might be a non-covered period, i.e. day 1 to day 60, which might matter if you need prenatal care during that period (a couple of weeks wouldn't necessarily matter but a couple of months might). My last company, benefits started the first day of the month following your start date; some companies have benefits that start on the first day of employment and some start a bit later.
posted by shoesietart at 10:40 AM on December 2, 2011

As always, most pre-existing conditions exclusions are avoidable if you can show what's called "credible coverage". The reason pre-existing conditions are excluded isn't just to be nasty but to avoid the moral hazard of people just getting health insurance when they're sick and dropping it when they aren't. If you can show that you actually had coverage before starting this plan, the exclusions are waived, because carriers understand that yes, they're now paying for you right away, but there's probably an equal number of people who leave their plan for a different carrier's plan right before they get sick. It all comes out in the wash.

According to the federal rules, "credible coverage" includes a "public health plan" established by a foreign country, like the UK's NHS. If you can provide some document that you were under the NHS, you should be fine. Registration card, letter from the NHS, whatever.

Note that this won't have anything to do with waiting periods imposed by your employers. Those aren't pre-existing condition exclusions, those are just periods you need to work before you're eligible for coverage at all. These are legal, and there's really no way around them. But as long as you don't need surgery or something right now, they're not that big of a deal.
posted by valkyryn at 12:10 PM on December 2, 2011

Pregnancy cannot be considered a pre-existing coverage per HIPAA, an act that defines both privacy and portability rules for many plans in the US. If you are on a plan that is subject to HIPAA, which is most any employer-provided plan, your pregnancy will be covered even if your coverage goes into effect the week before you deliver. This is a specifically delineated provision of HIPAA.
posted by pecanpies at 12:35 PM on December 2, 2011 [3 favorites]

Meant to add: you do not need to provide proof of prior creditable coverage for your pregnancy to be covered in the situation I deceived above. For any other conditions, you would.
posted by pecanpies at 12:37 PM on December 2, 2011

if you want to read the guidelines that pecanpies described - go here: http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html
posted by ejaned8 at 12:42 PM on December 2, 2011 [1 favorite]

Thanks, ejaned -I'm on my mobile device and didn't have that link handy.

To the OP: here's the relevant provision of HIPAA:

"Are there illnesses or injuries that cannot be subject to a preexisting condition exclusion?
Yes, as follows:
Pregnancy, even if the woman had no prior coverage before enrolling in her current employer's plan.

Conditions present in a newborn or a child under 18 who is adopted or placed for adoption (even if the adoption is not yet final), as long as the child is enrolled in health coverage within 30 days of birth, adoption, or placement for adoption. In addition, the child must not have a subsequent, significant break in coverage (defined as 63 days). For instance, a significant break might occur if a parent lost his job and health coverage for himself and his family shortly after a child’s birth. This break will be discussed in the Creditable Coverage section.

Genetic information. For example, if a woman is found to have a gene indicating she is at a higher risk for breast cancer, she cannot be denied coverage if there is no diagnosis of the disease."
posted by pecanpies at 1:07 PM on December 2, 2011

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