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Insurance question plz help DifferentDay Due June 2; 34 kids; Tennessee 3467 posts
14th Nov '12

I didnt know where to put this, so here it is. So I got notice my medicaid for the pregnancy is ending Nov. 28th. I just received insurance through hubby's work. It's Capitol Administrators and then it has First Health Network listed as well. Anyways, I looked on the EOB thing and this is what it says:

PRE-EXISTING CONDITIONS
The length of the Pre-Existing Conditions Limitation may be reduced or eliminated if an eligible person has Creditable Coverage from another health plan even if that coverage is still in effect. The

Plan will reduce the length of the Pre-Existing Condition Limitation period by each day of Creditable Coverage under this or a prior plan; however, if there was a significant break in the Creditable Coverage of 63 days or more, then only the coverage in effect after the break will be counted.

An eligible person may request a certificate of Creditable Coverage from his or her prior plan within 24 months after losing coverage and the Employer will assist any eligible person in obtaining a certificate of Creditable Coverage from a prior plan.

A Covered Person will be provided a certificate of Creditable Coverage from this Plan if he or she requests one either before losing coverage or within 24 months of coverage ceasing. If, after Creditable Coverage has been taken into account, there will still be a Pre-Existing Conditions Limitation imposed on an individual, that individual will be so notified.

Covered Charges incurred under Medical Benefits for Pre-Existing Conditions are not payable unless incurred 12 consecutive months, or 18 months if a Late Enrollee after the person's Enrollment Date. This time, known as the Pre-Existing Conditions Limitation period, may be offset if the person has Creditable Coverage from his or her previous plan.

A Pre-Existing Condition is a condition for which medical advice, diagnosis, care or treatment was recommended or received within six months prior to the person's Enrollment Date under this Plan. Genetic Information is not, by itself, a condition. Treatment includes receiving services and supplies, consultations, diagnostic tests or prescribed medicines. In order to be taken into account, the medical advice, diagnosis, care or treatment must have been recommended by, or received from, a Physician.

The Pre-Existing Condition does not apply to Pregnancy or to a Covered Person under the age of 19.




.... so does that mean the pregnancy is not considered pre-existing and they WILL cover it? I don't understand any of this and I've been searching for over an hour now trying to find a way to contact someone about it... can you help me?

[JadeLee] 1 child; Minnesota 12190 posts
14th Nov '12

This "The Pre-Existing Condition does not apply to Pregnancy or to a Covered Person under the age of 19." basically means that being pregnant that you don't have to worry about the above.

Leash25 2 kids; Philadelphia, Pennsylvania 1470 posts
14th Nov '12

thats what i'm guessing since it said a pre existing condition does not include pregnancy

DifferentDay Due June 2; 34 kids; Tennessee 3467 posts
14th Nov '12

I thought so too at first when I read that part but then confused myself lol hallelujah!!!! I'm doing the happy dance right now lol

SPF Insurance San Diego, California 3 posts
20th Dec '12

DifferentDay,




Regardless of what the EOB says, the federal HIPAA laws specifically say that pregnancy can not be excluded from coverage as a pre-existing condition when you are accepted into a group health insurance plan.



So you're good to go!