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Date of Conception vs Date of Coverage: Consumer Q&A

By on June 3rd, 2011
Filed: Advice, Facts, Health Insurance

Not all individually-purchased health insurance plans cover maternity care. In fact, pregnancy is often considered a “pre-existing medical condition” that can prevent you from qualifying for coverage (employer-based plans are different in this case). Even those plans that do include maternity benefits may require a waiting period of six months or more before maternity claims can be covered.

That said, there are some individually-purchased health insurance plans that do provide maternity coverage – and a few may do so without a waiting period. We took a question on Yahoo Answers last week from a woman who had apparently been approved for just such a plan. Her new coverage was scheduled to start in a few weeks but she wanted to know: if she and her husband conceived in the days before her coverage started, would the pregnancy still be covered?

Here’s the eHealthInsurance answer:

First, let me ask: Is this an employer-sponsored health insurance plan, or one that you bought on your own? It’s pretty rare for individually-purchased health insurance plans to cover maternity benefits right away, with no waiting period. However, it is possible. If that’s what you’ve got, count yourself lucky. I’d just recommend that you confirm this with your health insurance agent and ask him or her to point out to you where this is made clear in writing in the coverage details – for your own peace of mind.

Assuming that the maternity coverage on your new plan works like you say it does, you probably won’t have a problem if there’s some slight possible overlap in the date of conception and the medical confirmation of a pregnancy. When you apply for coverage with an individually-purchased health insurance plan, the insurance company makes a coverage decision based on all available data on hand at the time of your application. So long as you answered all questions truthfully on the application before they approved you, you should be fine.

About Douglas Dalrymple

Doug Dalrymple is a member of the communications team at eHealth, Inc. and has worked in the health insurance and technology industries for fifteen years. He works on communications strategy, content creation and management, project management, and corporate messaging.

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