Here is the story.. Both my wife and I work and have own health insurance plans though companies. I planned to switch her to my plan during the open enrollment in August as mine offers better benefits and it would be effective from September 1. Now, we just learned that my wife is 4-week pregnant. Will we have any trouble claiming for the pregnancy-related bills from my health insurance provider (Blue Cross Blue Shield) after the switch? Another question is that, the first doctor's visit is coming up in a few weeks. Could my wife use her insurance for the first visit, then use my insurance after the switch for subsequent visits as well as the baby delivery? Thanks!
2007-07-12 04:00:22 · 0 answers · asked by atlbkk03 1 in Business & Finance ➔ Insurance
Here in Nevada - insurance carriers are not allowed to put pre-existing condition exclusions for pregnancy on GROUP SPONSORED plans.
I am not sure of the laws in your state however - the general rule of thumb for all pre-ex conditions is: If you had health insurance coverage during the diagnosis and there has not been a lapse of coverage for more than 63 days there can not be any pre-existing conditions attached to the GROUP SPONSORED policy. This is verified through the evidence of coverage (EOC) that you will receive once your wife drops her plan.
The main thing to look at is your physicians - make sure the doctor she is going to visit in a couple weeks is also listed as a participating provider for your new health plan.
You shouldnt have any problems - just keep the physicans updated when you get your new ID cards.
Hope this helps!
2007-07-12 06:20:42 · answer #1 · answered by Rick 3 · 0⤊ 0⤋
The answer to your question depends on several factors, including what policy you are under, whether there is a break in coverage, and what state you reside in. While it is correct that group health insurance plans can impose pre-ex periods, your wife may be able to get credit for her prior coverage, reducing or eliminating any pre-ex period. For more information on this check out http://www.healthinsuranceinfo.net. The have some helpful guide about health insurance for all 50 states and DC.
2007-07-12 07:19:57 · answer #2 · answered by Anonymous · 1⤊ 0⤋
Double check with your plan, but as far as I know, as long as your wife does not cancel her policy until she's on yours (meaning, if it's effective 9/1/07, she needs to stay on her plan until 8/31/07) and can provide the certificate of coverage (a letter that she'll get from her plan when it cancels) to the new plan when they ask for it, they usually waive any pre-existing clause - make sure this is the case with your plan.
As for your second question - as long as the doctor is in network, it's totally fine to switch insurances midway thru. If they're not in your specific network - again, call your plan to make sure!! - then you might need to change doctors - also make sure that the hospital they're affiliated with is in your network - it'll save you headaches and money later!!
Good luck and congrats! =)
2007-07-12 05:48:49 · answer #3 · answered by zippythejessi 7 · 0⤊ 0⤋
most health insurance will have a waiting period. Waiting means no claim is allowed during this period. Normal waiting period is 1 month.
The other issue is specified illnesses or conditions, usually is 120 days from the inception date. (no claim is allowed during this period)
ask more info from the agent (new plan). and read the fine print
2007-07-12 04:18:22 · answer #4 · answered by Insurance 3 · 0⤊ 0⤋
It could be a hassle because of pre-existing condition (pregnancy) when you switch her to your plan. I think you should confirm with: (1) the HR/benefit admin at your company (2) the doctor's office. Congrats & good luck
2007-07-12 04:18:33 · answer #5 · answered by mathie 1 · 1⤊ 1⤋
No, not as long as she had maternity benefits under her old plan. Yes, you can switch plans mid-pregnancy.
2007-07-12 05:51:28 · answer #6 · answered by Anonymous 7 · 1⤊ 0⤋