She might also just need a job - she might have been laid off recently, etc. and be in the position of having to work. The woman I mentioned before did not have ulterior motives other than needing a paycheck. She did not receive medical benefits from the company and, as I said, she only took two weeks off (unpaid) for the birth. Admittedly, this was probably and unusual case (at least for the limited amount of time-off she took).
Otto is correct about pregnancy not being considered a pre-existing condition. I’m 5 1/2 months pregnant and on my husband’s insurance. He recently resigned in order to go to a different company. Before he did that, we researched it and found that my pregnancy (at least as of the effective date of the new insurance) will be covered. We’ll be on COBRA until then.
Okay. A short course on how pregnancy is billed, and why few insurance companies will cover one late in the game.
Assuming a woman stays with one OB during the entire pregnancy, the OB bills one code that covers both pre-natal visits AND his part of the delivery, along with routine post-partum care. The charge may be pro-rated in cases of miscarriage, if the mother changes doctors during pregnancy (as I did), or increased if there is a higher-than-average number of visits (as in high-risk pregnancy). Ultrasounds, labwork, etc. are billed separately.
Because it’s usually a package situation, the only thing the insurance would cover (if it covered anything at all; it’s the call of the insurance company, and ultimately it falls to how the contract was written in the first place) would be for delivery and the hospital charges associated with delivery. They would not pay a dime toward any charge incurred prior to the date the insurance took effect, whether it’s pregnancy-related or not. (I assume this was part of the question asked above.)
Something else to consider is that even though the insurance may have taken effect on the date of hire, it takes time to process the application. So, everything is on hold while the carrier enters the information into their computer system, and issues the ID card. The doctor’s office and hospital may not be able to get pre-authorization because the insurance company has never heard of the patient.
And if the hospital or doctor isn’t in the new network, the patient will either need to change providers or else face higher copayments and/or a deductible (YMMV, since that is contract-dependent).
Any way you look at it, it’s not a very good idea to change insurance companies during a major health event.
Group health insurance cannot consider pregnancy to be a pre-existing condition as long as the woman was covered by a prior creditable health insurance under a comprehensive major medical plan. This is mandated as part of the Health Insurance Portability and Accountability Act of 1996. See www.cms.hhs.gov.
As far as a new company not covering any pregnancy-related costs that occurred before the date of hire, well, why would they? That’s not what any group plan does for anyone, no matter what the medical condition. And if there’s a delay in getting into the system once a person is hired (assuming benefits start on day one), it’s not like that means that no benefits are ever payable – it just means the person might have to pay up front and once she is put into the system, she submits and gets reimbursed retroactive to the start date. Again, that’s nothing unusual, pregnancy or not.
It does seem to me that this situation could be abused. The reason I asked the question was because a woman was recently hired by my company that was around 7 months pregnant. During her interview she was wearing a large coat to disguise (my guess) the fact that she was pregnant. Of course it was obvious the first day she came in to work. She is now on maturnity leave. The company is now short handed because they do not have room in their budget to hire an additional person for that position. Her position, by the way, is a very low level position that most people would be qualified for.
I can see the benefits for this protection. However, in this particular instance, it seems like the woman took advantage of the company. Our medical benefits do begin at first date of hire. She is also being paid while on medical leave.
I don’t see that she was taking advantage of the company, TexasSpur. Since her pregnancy was legally irrelevant to the hiring decision, it shouldn’t have mattered whether she hid it or displayed it, and the hiring manager wouldn’t be allowed to ask. Basically, she prevented the company from getting the chance to skirt the edges of the law by finding an excuse to hire someone else … These situations are part of the cost of doing business in a society with civil rights protections at the level of ours.
Is there a defense against this kind of opportunism? Of course! Your company can legally delay medical benefits and paid leave-it’s not required to offer those from day one. Even the substantial protections of the FMLA don’t protect her during her first months. Your company’s unusually generous policies are bound to make it a target of this and other kinds of opportunism.
That does suck - unfortunately, there’s no law against her wearing pregnancy-hiding clothes. But under FMLA, they don’t have to hold her job for her since she hasn’t worked there for a year. I am not a lawyer and obviously your company should check things out with one, but since she’s not covered by FMLA, why don’t they just terminate her? Unless they want to avoid the hassle of her possibly counter-suing, baseless though it may be.
And she’s getting full pay, from the company (not from short-term disability) while she’s on maternity leave? That’s extremely unusual in the U.S. If she’s only getting STD, it’s probably only for 3 months at the most.
To clarify, I do think it sucks but I don’t think not announcing one’s pregnancy or making it obvious is taking advantage. She was just looking out for herself. If I really needed a job and was 7 months’ pregnant, I’d try to look un-pregnant too. If the company can’t figure it on their own, too bad for them.
On the other hand, I wouldn’t deliberately try to find a job in order to get maternity benefits either. (Not that that’s necessarily what she did.)
Regarding company benefits… My medical, dental and life insurance kicked in the day after I started working. Apparently their policy is it starts the 1st of the month following the start date. And I started on Sep. 30. I also got 2 weeks paid vacation, 8 personal days and 6 sick days once I was there for 3 months. It was pretty sweet. Of course they’re sticklers on attendance/punctuality. I got an email just today telling me that I needed to be more careful about my breaks since I was one minute late coming back yesterday…
