Aetna insurance?

Question

I recently got health care coverage through my work. i was told from a friend/employee that i have to wait a year before i can get pregnant. my husband and i are ready to have another child asap. i want to know if this is true?? if so, why do i have to wait a year? it doesnt make sense to me. someone please help!

Answer 1

Your best bet is to call aetna and ask. I have aetna and we have no such rule at our company but each employers coverage is different. It won't take long to place the call they can look it up to see what your insursnce will cover.

Answer 2

You need to check with Aetna specifically about your policy. The other posters have given you some good suggestions, and I'd recommend following their advice.

I'd be surprised if you do have to wait a year. That said, I could imagine a scenario where it could possibly happen. For example, if your employer is self-insured (with Aetna acting as an administrator for them) then the individual state Department of Insurance laws don't apply to them. Self-insured employer benefit plans are governed under the Federal ERISA act. If you've had a lapse in coverage prior to enrolling in this policy, then there's a possibility that you'd have a waiting period for maternity.

Like I said, I'd still be surprised if that were the case. But the only way you can know for sure if you fall under the rare circumstance where maternity could be pre-existing under your benefit plan is to call Aetna directly and ask!

Answer 3

Ok. Both previous answers were good, but missed a couple things.

1) Absolutely call the carrier. And document it. But to be safe, if they say that yes, you can have a baby with no waiting period, have them FAX YOU THE CERTIFICATE OF INSURANCE ILLUSTRATING THAT. Documentation is great, but it's the legal document that takes precedence and will be considered.

2) As another contributor had said, insurance is state-run. And they all have different laws. Here in Nevada, if there are 15 employees, maternity must be covered. Also, maternity may not be a pre-existing condition under Nevada law. So, you need to check with your state's DOI (Department of Insurance). It's a good idea, but as large as Aetna is, I doubt they wouldn't be following your state's laws.

3) Here is what's probably happening...You didn't have prior coverage before joining your group health plan (or had a lapse of more than 63-days) and you joined a PPO which has a pre-existing condition clause.

I would be happy to answer questions on a "friendly" basis as opposed to a "professional" basis. Feel free to email me.

Answer 4

According to the Health Insurance Portability Act, pregnancy is not considered a pre-existing condition. Therefore, all you need to confirm is that your policy has maternity coverage.

In my travels, I have only seen a handful of cases that excluded maternity coverage... mostly relegious organizations, Non-ERISA, TAFT or part time employee coverage for massive organizations.

HOWEVER, you may not qualify for other benefits such as FMLA (Family Medical Leave Act) and/or Aetna's supp disability product as they generally have 12 month waiting periods built into them for major claims. I it my unqualified guesstimation this is what the employee is speaking of.

Call Aetna: 877-249-2472 Option 6 and request that they send you an EOC (Explaination of Coverage) & plan design.

Answer 5

The only other thing that I would add to what everyone else has said is this: most policies do have a waiting period on certain conditions. If you've only paid a month's worth of premium towards your coverage, and hospital bills for a baby cost $10,000...... you get the idea.

Your absolute best bet is to call Aetna and get a detailed explanation of your policy.

Answer 6

If you had prior insurance with no lapse and you provided your new carrier proof with a "certificate of credible coverage," there should be no waiting period. However, you don't mention where you are from. Different states have different laws. In fact, most policies are required to pay for a pregnancy if you are covered at the time of delivery, not inception. Also, not every policy covers maternity .... in Indiana, employers are required to offer maternity coverage only if they have 20 or more employees. I agree you should call your carrier and document who said what and when!

Answer 7

Your plan might have a waiting period for things like pregancy. Because there are, without exaggeration, hundreds, if not thousands, of Aetna plans, you should call member services (the number is on your card) and ask for the specifics regarding your plan.

Answer 8

You need to check with YOUR policy, to see if there's a wait on maternity benefits. I wouldn't trust the word of a friend/employee, I'd check with the number on the back of your card.

Many times, there is - it DOES make sense, because otherwise people only buy the maternity coverage in the years they want to have a baby - no spreading of risk there.