Individual Health Insurance (with Maternity) for Couple in Indiana

somarco · 06-09-2009, 11:52 AM

Does Time write a full maternity waiver in Indiana? They do in GA and wondering if they are allowed to do likewise in other states.

IndyAgentIDTMY · 06-09-2009, 12:32 PM

Originally Posted by somarco

Does Time write a full maternity waiver in Indiana? They do in GA and wondering if they are allowed to do likewise in other states.

I don't think so...I believe all major medical plans are required to at least cover "complications of pregnancy" in Indiana even if they do no elect for maternity coverage. Regardless, I'll check that out and let you know what I find.

P.S. Bryan - If your wife has PCOS, won't she need fertility treatments to become pregnant? You may want to check into that, and I am not aware of any Carrier that will cover fertility unless you have a slick Provider who manages to lie on the medical history and coding to get them to pay for it for awhile...that is until the Carrier catches it and comes back for their money!
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Just got off the phone with Assurant. They can opt out but they are still required to cover "complications of pregnancy" even if the member does not opt for maternity.

somarco · 06-09-2009, 01:03 PM

If they cannot opt out of complications, did you ask if they would even tender an offer for coverage?

IndyAgentIDTMY · 06-09-2009, 01:26 PM

Thats a good point, Bob. They can still either accept or decline, but I've never submitted a client with PCOS to Assurant. Probably only one way to find out for certain.....

somarco · 06-09-2009, 04:33 PM

In GA they can offer a full maternity waiver, and have done so in the past on some challenging clients with similar issues. I had a PCOS client with Aetna for a few years. They don't write maternity here but did not consider the PCOS to be an issue should she get pregnant.

Either they know more than other carriers (not likely) or the wording on complications is such they felt confident they could skate on the claim.

As I said, I have used Time in the past because they are able to carve out all maternity related claims, including complications. Don't know how they do it, but they do.

CGI did the same thing when they were in the market.

I have only had a few clients with PCOS but this gave me a chance to update my Georgia health insurance FAQ page. I add to it daily as new, and sometimes old, situations arise.

bryan2449 · 06-10-2009, 07:50 AM

Originally Posted by IndyAgentIDTMY

P.S. Bryan - If your wife has PCOS, won't she need fertility treatments to become pregnant? You may want to check into that, and I am not aware of any Carrier that will cover fertility unless you have a slick Provider who manages to lie on the medical history and coding to get them to pay for it for awhile...that is until the Carrier catches it and comes back for their money!

Sometimes this is the case... but not with her (at least not initially). We have gotten pregnant before, but it ended in a miscarriage - the OBGYN familiar with my wife's condition said that it is possible that it was PCOS related but she thought that it was just a case of first time pregnant / genetic anomoly. So anyway, yes all carriers in Indiana have to cover complications in pregnancy with or without maternity coverage.

Originally Posted by IndyAgentIDTMY

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Just got off the phone with Assurant. They can opt out but they are still required to cover "complications of pregnancy" even if the member does not opt for maternity.

So what does this mean exactly? Im not sure I understand...

CHUMPS FROM OXFORD · 06-10-2009, 08:46 AM

Virtually all carriers must cover "complications of pregnancy,"...assuming they approve the policy.