Question
Alabama
I am currently in the process of changing jobs. I have been under the same health insurance goup policy for the past 14 months. My wife is currently pregnant and my new employer states that they consider this diagnosis a pre-existing condition for which they impose a 270 day waiting period for coverage. It is my understanding that the HIPAA act of 1996 prevents an employer from imposing pre-existing conditions when moving from one group policy to another. When I asked the human resources about this, I was told that my employer "opted out of the HIPAA act". I further delved into, "how do you opt out of a federal act?" For which the reply was, I don't know but our administrators say that ALL new employess have to wait out a 270 day waiting period for coverage.
My question is primarily, can an employer "opt" out of following a federal act? And secondly, how should I proceed in investigating this and trying to make them cover this?
Thank you.
Answer
No, an employer cannot opt out of a Federal law. Your recourse is to file a complaint with the US DOL.
Here is the relevant link. Scroll about two thirds of the way down to the question, What is a Pre-Existing Condition?
Answer
Are they saying they won't Offer health coverage for your first 270 days, or that they will offer it, but nothing that is preexisting is covered? I'm assuming the second, but it almost sounded like the first, which is legal.
Answer
They are saying that they will offer coverage, but require a 270 day waiting period for coverage of anything that is considered pre-existing including pregnancy (based on conception date not diagnosis date).
Answer
They are in for a very nasty shock.
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Under HIPAA, pregnancy can NEVER be considered a pre-existing condition, even if there was no prior creditable coverage under another group plan. I forsee problems in your employer's future...
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UH ohhhhhhhhhhhhhhhhhhhhhhhhh!
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My only thought is maybe this is a little tiny company and the health insurance is not a section 125 plan?
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Wouldn't matter even if that were the case. HIPAA's prohibition against pregnancy being considered pre-ex is not dependent on there being a Section 125 plan. It's prohibited, period.