Is pregnancy a pre existing condition short term disability

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Any condition (either physical or mental) including a disability for which medical advice, diagnosis, care, or treatment was recommended or received within the 6-month period ending on your enrollment date in a health insurance plan. Genetic information, without a diagnosis of a disease or a condition, cannot be treated as a pre-existing condition. Pregnancy cannot be considered a pre-existing condition and newborns, newly adopted children and children placed for adoption who are enrolled within 30 days cannot be subject to pre-existing condition exclusions.

Short-term disability insurance policies cover time off work for pregnancy and childbirth. This coverage can offer some income if you have to miss work due to late-stage pregnancy, pregnancy complications, childbirth, and recovery. Unless you live in a state that offers short-term disability benefits (for example, California, New York, New Jersey, Rhode Island, and Hawaii), or your employer provides you with group short-term disability insurance, you may want to buy your own policy through an insurance provider.

Cost of Short-Term Disability Benefits

Premiums for a short-term disability policy aren't cheap, but it can make sense to get this coverage for a planned pregnancy rather than miss work for weeks or months without pay while you experience pregnancy complications or childbirth. And if you pay for your own disability insurance, the benefits aren't taxable. Most short-term disability policies pay up to two-thirds of your income.

You can expect to pay around $50 to $100 a month for an individual short-term disability policy that provides about $3,000 to $5,000 a month in benefits while you're off work.

Length of Short-Term Disability Coverage

Before you buy short-term disability, investigate what exactly the policy covers in terms of pregnancy benefits. For example, if you are on bed rest due to pregnancy complications for three months before your due date, will your coverage kick in so that you get a portion of your income during that time? How many weeks of benefits will you get after childbirth to allow you to heal and spend time with your baby? Many policies cover you for six weeks after childbirth; eight weeks after a C-section, since you need more time to heal after surgery.

You may be also able to get your benefits extended after childbirth. If you have a postpartum disorder or childbirth complications that leave you unable to work for more than six to eight weeks afterward, you should continue to be able to receive benefits. You will typically need a note from your doctor stating that it is medically necessary that you stay home or in the hospital.

When to Purchase Short-Term Disability Coverage

In most cases, you have to sign up for short-term disability before you become pregnant if you want the coverage to extend to the pregnancy. Insurance companies that sell short-term disability policies are allowed to exclude preexisting conditions, and pregnancy would be considered one if you buy a policy while you're pregnant.

However, if you sign up during the pregnancy, you can still be covered for unexpected illnesses or accidents that are unrelated to your condition. Some policies cover mental health issues like post-partum depression as well.

Every mother-to-be dreams of what the future will hold with your new bundle of joy. You want to do everything you can to assure it will be the best possible future. While no one plans to have a complicated or difficult pregnancy and or delivery, it happens and you want to be prepared. New long-term disability claims resulting from pregnancy and childbirth represent about 10% of new claims for women.1

Planning ahead financially can help to lead to stress-free maternity leave with your new baby, but what if you;

• Suffer a complication during the pregnancy that leaves you unable to work for months before you deliver?
   
• There is a complication during delivery and you have suffered a medical condition that prevents you from returning to work after 6-12 weeks of maternity leave?

What is the Solution?

An individual disability insurance policy can contain a provision that will cover complications of pregnancy so long as the complication causes you to suffer a medical condition that keeps you from working or returning to work, for longer than the 90-day elimination period.

The key to obtaining a policy that will cover you for such unexpected events during your pregnancy is to purchase the policy before you become pregnant. Insurance companies consider pregnancy a pre-existing condition if you are already pregnant when you apply for the coverage. They will exclude your current pregnancy from the coverage.2

Can I Cover My Current Pregnancy?

We receive phone calls every day from women who are currently pregnant and looking to purchase a policy to protect their incomes should a complication arise. It is one of the most common calls we receive. Unfortunately, most women are surprised when we have to tell them that since they are already pregnant, they cannot buy a policy to cover their current pregnancy. 

We try to explain that it is similar to having an accident with your car, then purchasing the auto insurance after and wanting the insurance company to pay for the already existing condition of the car. Therefore, if you are planning a future family, apply for your disability insurance policy now, before you are pregnant. 

Some Good News

There is good news even if you are currently pregnant but have not purchased a policy yet. The good news is that most likely, you can still purchase a policy. However, this policy will exclude your current pregnancy and would not cover you should you suffer any complications. But this does not mean you should not buy your policy now. 

There are a few things to keep in mind about buying disability insurance. If you purchase the policy now while you are pregnant, yes, your current pregnancy will not be covered, but you will be buying coverage at a younger age, so you will be paying a lower premium. Also, once you have delivered your baby and you are back to work full-time, you can have your exclusion reviewed to see if it can be removed. If it is removed, assuming you had an uncomplicated, normal pregnancy and delivery, then any future pregnancies will be covered by this policy should you suffer a complication that lasts longer than your elimination period. 

You should buy a high-quality disability insurance policy to cover any illness or injury, although not your current pregnancy, while you can lock in a lower premium at your age now, and your health now before you get older and have to pay more or possibly suffer an illness or injury that could prevent you from buying a policy at all in the future. 

Keep in mind that if you have had any type of fertility issue, miscarriage, or similar issue, in the past, the insurance company will exclude for pregnancy even if you are not pregnant, as these too are pre-existing conditions. But this exclusion could be reviewed and removed if you have a normal, uncomplicated pregnancy and delivery in the future-- so again, any other future pregnancies could be covered later once the exclusion has been reviewed and removed. 

Individual disability insurance plans do not cover normal, uncomplicated pregnancies or maternity leave, and most pregnancies do not result in payable long-term disability claims. Typically, in order to cover a normal 6-12 week maternity leave, your employer would need to offer a group short-term disability policy that has a provision to cover you for maternity leave. These group short term disability insurance plans can be paid for your employer, or they can be paid for by the employees themselves. These plans usually pay you a percentage of your income, such as 60% for the first 6 weeks of maternity leave and then may reduce in benefit amount. For example, they may reduce the 60% to 40% of income for weeks 7-12 of maternity leave if you take all 12 weeks of maternity leave. 

Individual short-term disability plans do not pay for normal maternity leave, so there is not a way to secure a plan yourself individually for your maternity leave if your employer does not offer an option for such a short-term disability plan. If you find yourself without a group short-term plan, as most women do, (most employers do not offer these types of plans), then be sure to plan ahead and save enough money to cover your bills, spending needs, and new baby needs in the short term while you are on maternity leave. 

As with any type of insurance, you need to buy it before it is too late. As you are planning your family and your future, be sure to plan for your financial future as well. As women, we need to plan in advance of building a family and purchase a long-term disability insurance policy before we become pregnant so that any type of long-term complication that could occur can be covered under our policy. Knowing you have done the proper planning to financially cover you and your family in the event of an unfortunate complication during your pregnancy will help to ease your mind during such as exciting time of your life--your pregnancy and your new baby’s arrival.

An individual’s eligibility for benefits is determined on a case-by-case basis, taking into consideration the factual circumstances presented as well as the terms and conditions of their policy. 

1 https://disabilitycanhappen.org/disability-statistic/
2 In Texas, companies can put a pregnancy exclusion on a current pregnant applicant, but the exclusion wording does not have pregnancy complications included. In California, not all companies will offer a policy to pregnant women in their 3rd trimester of pregnancy, as other states will. 

This material contains the current opinions of the author but not necessarily those of Guardian or its subsidiaries and such opinions are subject to change without notice.

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