The company I work for has Aetna insurance to cover for my healthcare needs. How true is it that with Aetna insurance, I have to wait for a year to get pregnant?
One reason may be the agreement between your employer and Aetna insurance. Your employer may be self-insured. This means that Aetna insurance is administering the company’s healthcare coverage. If your employer is self-insured, then state laws on insurance are not applied to them. Healthcare coverage by self-insured employers is governed by the ERISA Act or the Employee Retirement Income Security Act. Under this Act, there should be no lapses in your payment for healthcare coverage for more than 63 days before you got Aetna insurance. If this is the case, there is a waiting period before you can use the maternity benefits of your Aetna insurance. If not, and you have prior health insurance before getting Aetna insurance, then you must request a Certificate of Credible Coverage from your previous insurer. If this is indeed the issue, this Certificate will help facilitate your immediate use of the maternity benefits of your Aetna insurance. Another reason may be the time when you got your Aetna insurance. If you got it just recently, and you only paid one month of premium, then this amount may not be enough as of now to cover for the baby’s hospital bills. Maternity expenses usually cost almost, if not more than, $8,000. Aetna insurance might require several months of monthly premium payments before they can pay for big medical bills, such as your maternity expenses. It might also be possible that maternity is considered a pre-existing condition in your particular Aetna insurance policy. There are different types of Aetna insurance policies. If you call Aetna insurance, you might inquire if your policy is covered by the Health Insurance Portability Act. This Act requires pregnancy to be classified as a medical condition and not a pre-existing condition. Another explanation may be your eligibility to use the benefits provided by the Family Medical Leave Act and/or Aetna’s supplementary disability insurance. These two types of health insurance usually have a one-year waiting period for you to use the major benefits, including maternity coverage. Take note that mandated maternity coverage depends on the State you’re living in. Insurance laws vary across States, including the provisions for maternity coverage. You might need to check your State’s Department of Insurance if maternity is considered a pre-existing condition in your state. In some States, health insurance only pays for expenses incurred during delivery, and excludes pre-natal expenses. These are possible reasons to explain your problem. It is still best if you call Aetna insurance directly and let them explain your policy in detail. The number for call member services is indicated on your card. You can inquire more on the specifics of your healthcare coverage. To document your discussions, you can request for an EOC or Explanation of Coverage and insurance plan design to make your request official. You can also ask them to send you a certification that you need not wait for a year to make use of the maternity benefits of your plan. You can use these documents in case there may be future problems related to your use of the maternity benefits from your Aetna insurance. Answer by moderator — May 28, 2009 @ 3:23 am No CommentsNo comments yet. Leave a comment |
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There may be several reasons to explain why you have to wait a year to get pregnant and use the maternity benefits of Aetna insurance.
