Short Term Disability Pregnancy Pre Existing Condition


Share post:

Was The Pregnancy A Pre

Can I get around a pre-existing condition limitation in a disability policy?

The first thing to consider is how long you were with the employer before taking leave for a pregnancy when the Short Term Disability coverage took effect whether you were pregnant before the STD insurance coverage took effect, and whether there is a pre-existing condition exclusion in the short term disability policy.

It is very common for short-term disability policies through employers to consider pregnancy a pre-existing condition. If there is a pre-existing condition exclusion and you were pregnant when the STD coverage took effect, you may not be eligible for STD benefits relating to pregnancy until 12 months after the short-term disability coverage took effect.

Understanding this pre-ex issue is very important when determining whether to purchase short-term disability insurance. You can still buy the policy, but you typically need to pay for it for a full year before you can use it for pre-existing conditions.

Is Pregnancy A Disability

Pregnancy itself is not a disability. However, you may be unable to work due to complications or while recovering from labor and delivery.

Roughly one in five women experience complications during pregnancy. These can include:

  • High blood pressure
  • Stillbirth and miscarriage
  • Worsening or acceleration of an underlying medical issue like multiple sclerosis, asthma, or epilepsy

Notably, women with pre-existing conditions, like diabetes, hypertension, obesity, or substance use, are more likely to experience pregnancy and labor complications. Older expectant mothers are also more prone to pregnancy and labor-related issues.

These conditions can make it difficult to work during your pregnancy and after labor and delivery. In this case, you could be eligible for short-term or long-term disability benefits.

Insurance policies define disability in one of two ways:

  • Own occupation: you are eligible for benefits if you cannot perform the duties of your job due to an illness, injury, or chronic medical condition.
  • Any occupation: you must prove that you cannot perform any type of work because of your health conditions.

If pregnancy-related conditions make it impossible to do your job or any job in the economy, you might qualify for a monthly benefit payment. You can determine which standard applies to you by reviewing your policy or plan documents.

RELATED: How Are FMLA and Short-Term Disability Different?

Review Your Maternity Coverage

Did you know maternity coverage is one of the 10 essential health benefits? That means all health insurance plans must cover maternity services, including:

  • Postnatal doctor visits
  • Newborn baby care
  • Lactation counseling

While these are covered services, it doesnt mean your insurance will pay the entire cost. Chances are, youll still be billed for a portion of the costs, especially if you have a higher deductible. Make sure to review your deductible, out-of-pocket costs, and coverage so youre better prepared for the costs ahead.

Also Check: Mortgage Assistance For Disabled Homeowners

How To Get Short

How do you get short-term disability approved while pregnant so you can enjoy maternity leave benefits? Is my pregnancy a pre-existing condition?

These are essential questions for women facing unpaid time off from work. You will find the answers here plus some alternatives.

First, we must point out that the words apply and approved can both pertain to two separate transactions that might have opposite conclusions.

For instance, the insurance company might approve your application for a new policy but deny your subsequent claim for benefits.

Learn how timing affects your possible benefits and why it makes sense to buy a supplemental policy at work no matter when you conceive or give birth.

Applying For Disability Coverage During Pregnancy

Disability Insurance

If you just started a job that offers disability insurance, you should be able to sign up for coverage and receive any benefits available without issue. Employer plans buy coverage for many employees at once and dont typically require medical underwriting you dont have to answer health questions or undergo a medical exam. Pre-existing condition limitations may apply review your policy or check with HR for additional details.

Its different when you buy disability insurance on your own. Individual policies, or voluntary group policies whether STD or LTD typically require medical underwriting, and pre-existing conditions are typically excluded. If you apply during your pregnancy, it will be considered a pre-existing condition. While the insurance company may write the policy, any disability or claim relating to pregnancy will probably be excluded.

Recommended Reading: Property Tax Relief For Disabled

Can I Get Disability For High Risk Pregnancy

Under the federal Americans with Disabilities Act , if you work for an employer with 15 or more employees and have a pregnancy-related disability, which may include examples such as a high-risk pregnancy, gestational diabetes, or preeclampsia and that disability substantially limits a major life activity you may …

Pay Into Your Health Savings Account Or Flexible Spending Account

What are HSAs and FSAs? Theyre special accounts you fund with pre-tax money that you can use to pay for out-of-pocket health care costs . These can help you save on taxes while helping to pay for maternity expenses such as breastfeeding supplies , prenatal vitamins, and so on. Note that there is one key difference between HSAs and FSAs: You can roll over unused HSA money to the next year, but unused FSA money is lost. So, you shouldnt fund an FSA with more than you think youll need that year, but you dont have to worry about overfunding an HSA.

Theres nothing more important than bringing a new child into the world. With a little financial planning ahead of time, youll be able to focus more on your baby and make the most of a special time in your life.

Don’t Miss: Va Disability Percentage By Condition

California Pregnancy Disability Leave Law

California has a Pregnancy Disability Leave Law. Under this law, women who are pregnant cannot be discriminated against. Additionally, the law requires employers to give 4 months off to employees for pregnancy, childbirth, and pregnancy related conditions. Like the Family Medical Leave Act this leave is unpaid and is not considered maternity leave. So, it is not intended to provide the benefits that medical disability does.California Family Rights Act offers an additional 12 weeks off in addition to the 4 months of pregnancy leave. This is a total of seven months off, potentially, if the disability leaves the employee unable to work for a longer period of time.

Read Also: How Long Till You Feel Pregnant

Fmla Protects Your Job While You Take Leave But Not Your Income

What is Short-Term Disability Insurance?

While theres no national standard for maternity leave length, the Federal Family Medical Leave Act protects your job for up to 12 weeks if you need to take time off to care for a newborn or adopted child, or an ailing family member. But while employers are required to hold your job for you, they are not required to pay you during a medical leave. Its also important to note that not every employee is eligible heres whats needed to qualify for FMLA protection:

  • Your employer has at least 50 employees in a 75-mile radius
  • You have worked there at least 12 months
  • You have worked at least 1,250 hours in the past year

Also Check: Va Disability Rates By Condition

Pregnancy Complications Can Be A Pre

If you have a history of pregnancy complications or fertility problems, the disability insurance company might argue that future difficulties are due to a pre-existing condition. For employer-sponsored disability insurance plans, there is typically a look-back period. With these policies, if you experienced pregnancy complications during the year before you enrolled, they might be a pre-existing condition.

If you have an individual or voluntary disability insurance policy, review it carefully. Sometimes, underwriters will exclude pregnancy complications if you have a history of preeclampsia, gestational diabetes, or stillbirth.

RELATED: Disability Exclusions: We Answer Your FAQs

States With Paid Family Leave Laws

Recognizing the importance of parental leave, more and more states are enacting PFL laws that go a step beyond FMLA by providing paid leave for employees who need to take off. Those states are:

  • The District of Columbia

Each state sets its own rules about which employees and situations qualify for paid leave, how long paid leave lasts, how contributions to the paid leave fund are made, and the benefit amount. If you live in one of those states, go to the state government website and search for Paid Family Leave to find out the specific rules and benefits for where you live.

Read Also: What Type Of Doctor Does Disability Evaluations

Consider Other Ways To Get Financially Prepared For Maternity

Theres no getting around it: having a baby is a big financial commitment. But a little planning can go a long way toward helping relieve any financial stress you may be feeling. Jeannie Jackson, a Guardian financial representative recently sat down with Gaby Dunn of the Scary Mommy video series for a maternity leave interview.

What Is Considered A Preexisting Condition For Short Term Disability

Survey May Offer Insights into Opportunities for CUs Around Unpaid ...

How insurance companies assess an existing condition depends on its severity and how long you have it. The company`s underwriter will review your medical records. They will assess how the condition is treated, how often it requires medical treatment, and what prescriptions you take. The eligibility and eligibility criteria depend on the type of short-term disability coverage you have group or individual. For example, if you have employer-sponsored disability insurance, you will need to meet the requirements of active work, which means you will have to work a minimum number of hours per week. If you are unable to meet the requirements of active work due to a disability and have exceeded the waiting period and the limitation periods for pre-existing conditions, insurance coverage can be used to replace part of your salary. If you can purchase short-term disability insurance from your employer or another group at a reduced cost or at no cost at all, do not hesitate to take advantage of the benefits. Even if you have this as an option, you should also save money in an emergency fund. That`s because most short-term disability policies only pay a fraction of your income in benefits. You may need to rely on a savings account to fill this gap and avoid going into debt. Many employers offer their employees short-term disability insurance coverage in the form of a group plan. Many companies even pay the full bonus for their employees.

Read Also: Bath Chair For Disabled Adults

What You Need To Know About Short Term Disability Benefits And Pregnancy

Having a short-term disability insurance policy can be a great way to supplement your income when you are out for maternity leave. Many major insurance companies, such as Cigna, Lincoln, Unum, Hartford, Standard, and MetLife offer short-term disability policies. There are always many questions regarding short term disability and pregnancy:

  • Can you apply for short term disability while pregnant?
  • Will you be approved for benefits while pregnant?
  • How much will my benefits be if I am approved?

Short Term Disability Vs Ssdi

Another common belief is that Social Security Disability Insurance can cover temporary disabling events. While this is true in some cases, SSDI benefits are the most difficult to qualify for.

Social Security generally will not consider you disabled if you work and earn more than $1,220 in a month. If you are not working, Social Security will consider whether you can work. If you can, you will not qualify for SSDI benefits – even if itâs not the type of job you did before your injury or illness.

According to the Social Security Administration, only 34 percent of SSDI claimants had their applications approved from 2006 to 2015. Even if you qualify for SSDI, benefits will likely replace only a small fraction of your income. The average monthly disability benefit in 2017 was $1,172.

Don’t Miss: Negatives Of Getting Social Security Disability

What Is A Pre

In the insurance business, a pre-existing condition is any medical issue, illness, injury, or chronic condition, which occurred prior to the insurance coverage you want to obtain. Under the Affordable Care Act , no one can be denied health insurance due to a pre-existing condition. However, disability and life insurance are different pre-existing conditions are taken into consideration when issuing a policy. Your pre-existing condition will be assessed based on the treatment you have received or are receiving. The treatment will be included in your medical records and you can be sure the insurance company will be looking closely for anything that could compromise your health.

Disability insurance is meant to safeguard your income in the event of an injury or illness that prevents you from working. If you have a pre-existing condition, there is an increased chance you will need to collect a disability benefit something the insurance company would like to avoid. The same thinking applies to life insurance: a condition that increases your chance of dying may prevent you from getting life insurance coverage.Some insurance companies will automatically deny you any coverage if you have a pre-existing condition. If they offer you insurance, there are two other coverage options they may exercise. The rules vary from company to company.

Unum May Misinterpret Medical Records To Deny Your Claim

Short Term Disability Insurance For Pregnancy

Even if you have short-term disability insurance coverage, insurance companies like UNUM may try to deny your claim by skewing your medical records. Insurance adjusters will look through your medical treatment history, including tests, doctors visits, and medication logs, looking for evidence of a pre-existing condition.

For example, suppose you were in a car accident and suffered a serious back injury. You file for short-term disability benefits while recovering from spine surgery. During UNUMs investigation, the adjuster notices that 12 months before the crash you mentioned a minor back ache to your doctor. They prescribed you a short course of pain medication, and your problems resolved themselves.

Even though you know you pulled a muscle doing lawn work, UNUM might argue that those twinges of pain were signs of a pre-existing herniated discand deny your claim.

Recommended Reading: How To Get Disability In Ga

Health Insurance And Pregnancy: What You Need To Know

Category: General

From buying diapers to creating a birth plan, theres a lot to prepare for when youre expecting a child. While you probably wont be gifted health insurance at a baby shower, its still a vital part of your pregnancy experience.Understanding your coverage can help you better prepare for the claims process before and after childbirth. Here are some tips to help ensure youre in-the-know.

Long Term Disability Coverage Can Provide Further Protection

If you have long term disability insurance that you purchased through the workplace or as an individual from an insurance company, it typically wont cover a typical pregnancy and recovery, due to the longer elimination period required under an LTD plan. However as with STD coverage complications are another matter, and if an issue renders you unable to work, it will generally be covered if the disability satisfies the benefit waiting period for the LTD. Also, pregnancy can worsen other conditions that may have been dormant or under control, such as diabetes or multiple sclerosis. Post-partum depression can be issue for people who have never experienced mental health issues, and if it causes you to miss work it could be covered by your LTD policy.

One thing to remember about LTD coverage: compared to short term disability, theres typically a much longer waiting or elimination period until benefit payments start. The typical STD plan has a 2-week waiting period with an LTD plan, the elimination period commonly lasts 60-90 days, but it can be as long as a year.

Recommended Reading: Disabled Veterans Benefits By State

Short Term Disability Vs Workers’ Compensation

It’s important to remember that short term disability insurance is different from workers’ compensation insurance, which provides coverage for injuries that occur on the job. Nearly 90 percent of disabilities are not work-related. Therefore, they are not covered by workersâ compensation.

If an injury or illness that limits your ability to work was caused by something unrelated to your job, workers’ compensation will not cover your lost income. Likewise, if you are injured or get sick from performing your job, short term disability insurance likely will not provide benefits during your absence from work.

Learn More:Workers’ Comp vs. Disability

I Was Approved For Voluntary Disability Benefits From Hartford Will Benefit Deductions Be Taken From That Check

Travel Insurance Companies Covering Pre

No, you will need to make arrangements with the vendors directly for premiums other than health, dental, Basic Life insurance, or Personal Accident insurance. During an unpaid leave of absence, the Human Resource Information Center should be contacted for arrangements about the Basic Life insurance, or Personal Accident insurance premiums. As for health and dental insurance, you should be COBRA notified.

Don’t Miss: How To Change Va Disability Direct Deposit

What Should I Do Prior To My Std Benefits Expiring

For benefit eligible employees with 3 years of full-time, continuous service, you may also be eligible for Duke Disability coverage. Please contact the HRIC at 919-684-5600 and ask to speak to the Disability Analyst.

If you have less than 3 years of full-time, continuous service, you may be eligible for benefits under the voluntary Long Term Disability plan, if you are enrolled for that coverage, subject to all terms and conditions of the LTD plan. Please contact the HRIC at 919-684-5600 and ask to speak to the Disability Analyst.

For a voluntary long term disability claim, please file your claim within 60 days after your date of disability to allow for proper processing.

What Are Some Examples Of Pre

Chronic illnesses and medical conditions, including many forms of cancer, diabetes, lupus, epilepsy, and depression may be considered pre-existing conditions. Pregnancy before enrollment is also considered pre-existing and chronic. Other less severe conditions such as acne, asthma, anxiety, and sleep apnea may also qualify.

Don’t Miss: Short Term Disability For Mental Health

Related articles

Can’t Work Due To Disability

Can You Get Disability For Migraine ...

Back Pay For Va Disability

Who Can File A Va Disability Claim ...

Filing For Disability In Nc

The Disability Application Process VA...