disability and pregnancy - Pre-ex??

Gomez · October 2001

My STD/LTD carrier has informed me that they cannot exclude pregancy from the pre-existing clause in our STD plan. I have been told that the underwriters stated that it is all or nothing - we cannot exclude pregnancy alone from our pre-ex clause. Our health insurance plan (and previous plans I have worked with) exclude pregnancy from pre-ex conditions?

They informed us that the alternative is to eliminate pre-ex conditions altogether. Honestly, this whole thing sounds fishy to me. What liabilities would eliminating pre-ex conditions from our plan open us up to?

Has anyone else heard of this and if so, what is the reason??

Thanks in advance.

Terry · October 2001

I believe that there was a court case or legislation recently (in the last year or so) that found having pregnancy as a PreX is discriminatory toward women and it now cannot be excluded.

System · November 2001

Yep. That sounds right to me.

James Sokolowski
Senior Editor
M. Lee Smith Publishers

Margaret Morford · November 2001

Isn't it also prohibited under HIPPA?

Margaret Morford
theHRedge
615-371-8200
[email]mmorford@mleesmith.com[/email]
[url]http://www.thehredge.net[/url]

Gomez · November 2001

I have just received clarification about this.'

HIPPA only prohibits this for medical insurance plans, not STD plans.

The Pregnancy Act states that you cannot treat preganancy (and be discimnatory) nay harsher than any other illness, etc. Therefore it is ok to include in a pre-ex clause for a STD plan.

Ethically, I dont agree but keeping it in a pre-ex clause is within compliance.

JustAnEmployee · November 2001

I'm a pregnant woman whose current employer is going into a merger before
my baby is delivered. Concerns about losing my maternity leave prompted me
to see an employment lawyer last month. He explained that if a short term
disability plan covered any illness such as heart attack, etc., then it must
also cover maternity. If the plan does not cover maternity, but does cover
other illness/sickness, the employer is in violation of the Pregnancy Discrimination Act which is Federal law. He also further went on to explain
that some states place further restrictions on employers as well. Based on
his statements, I believe that the clarification that you've been given is
incorrect. Please contact an employment attorney in your state.

Gomez · November 2001

Our plan does cover maternity leaves - we were not being discrimnatory towards pregnant women and were in compliance with the Pregnancy Act. However, if a woman joined the company while pregnant, she would have been subject to the pre-ex clause (the same as if she joined the company with an other pre-existing condition).

In order to alleviate the confusion, the company has decided to not have a pre-existing condition clause on our STD plan and our carrier has agreed not to increase our rates until our renewal as a result.

disability and pregnancy - Pre-ex??

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