Group health insurance during a pregnancy

KM | July 2, 2008

Q: Are there group plans that will cover my wife who is 12 weeks pregnant under my business?

A: Yes, when a small business group insurance plan starts, all full time employees and their dependents are immediately eligible for coverage regardless of pre-existing medical conditions or whether they previously had insurance. Group insurance plans are "guaranteed issue" which means that coverage cannot be denied to a business that meets the eligibility standards. This means that small group insurance is the likely solution if you wife needs coverage now.

There are several other related issues to consider:

1. Takeover coverage for pre-existing medical conditions like this pregnancy typically depends partly on prior insurance under federal HIPAA law. In addition, some pregnancy expenses are pro-rated over the term of the pregnancy. Others are mandated as immediately available under all circumstances. If your wife did not have prior insurance coverage, it may take some work to understand what is immediately covered under the new insurance plan. (These problems are avoided by maintaining continuous insurance coverage).

2. Businesses where the only employees are a husband and wife are treated under individual insurance laws and not small group insurance laws in some states.

3. Each insurance company may establish its own standards for an eligible business. Some require a certain length of time in business, a business license or evidence of a previous wage tax return as evidence of eligibility.

4. Employees have to work 30 hours per week to be eligible for group health insurance in many states. This is verified through a wage tax report.

5. Supplemental group health insurance plans at MedSave.com like Core Health Insurance, Basic Health Insurance and Value Benefit Plans are immediately available in your situation, but you should resolve the primary coverage issue first. MedSave.com does not handle small business group major medical policies because these do not fall into the category of low cost health insurance. In fact, these are among the highest priced health insurance plans. Individual major medical insurance plans are not available during a pregnancy.

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