Is Pregnancy a Qualifying Event?

No, pregnancy is not considered a qualifying event in most states. This means an expectant mother cannot be added to a group health plan as a dependent simply because she is pregnant. However, certain life events do qualify employees for special enrollment outside the standard open enrollment period. These include:

Giving birth to a child
Adopting a child
Placing a foster child in the home

These qualifying life events allow employees to update their health insurance coverage when a new dependent joins their family.

Questions About Insurance and Pregnancy

When an employee finds out she is pregnant, one of the first questions directed at HR is often about insurance coverage. Understanding what qualifies as a life event under health insurance policies is crucial for both HR professionals and employees to ensure the right coverage is in place.

What Is a Qualifying Life Event?

A qualifying life event (QLE) is a major change in an individual’s circumstances that allows them to adjust their benefits outside of the open enrollment period.

Typically, open enrollment occurs toward the end of the year, but certain life events enable employees to make mid-year changes to their health insurance. Common qualifying life events include:

Marriage or divorce
Birth or adoption of a child
Loss of existing health coverage
Changes in dependent eligibility

Since pregnancy itself is not a qualifying life event, employees must wait until the birth of the baby to update their health insurance plan.

Is Pregnancy a Pre-existing Condition?

Under the Affordable Care Act (ACA), pregnancy cannot be classified as a pre-existing condition. This means that if an expecting mother needs to enroll in a new health plan during open enrollment, insurers cannot deny coverage or charge higher premiums due to her pregnancy.

However, while maternity care is covered, employees are still responsible for:

Understanding the out-of-pocket costs for maternity care can help employees plan financially for prenatal care, delivery, and postpartum expenses.

What Other Insurance Options Do Pregnant Mothers Have?

While pregnancy itself is not a qualifying event for special enrollment in employer-sponsored plans, pregnant women may have other options for coverage, including:

Medicaid – Available for low-income individuals; eligibility varies by state.
Children’s Health Insurance Program (CHIP) – Covers prenatal and postpartum care for eligible individuals.

Both Medicaid and CHIP allow enrollment at any time during pregnancy, providing important coverage for expectant mothers who qualify.

What Else Should Employers Know About Pregnancy?

HR professionals should be prepared to answer questions about maternity benefits, parental leave policies, and employee rights. Here are a few key areas to consider:

1. Qualifying Life Events and Newborn Coverage
Although pregnancy is not a qualifying event, the birth of a child is. Employees should be reminded that they can:

Enroll their newborn in their health plan
Adjust their benefits following the birth
Meet deadlines for making coverage changes

Encouraging employees to review their health insurance options before giving birth can help prevent lapses in coverage.

2. Pregnancy and the Hiring Process
Under the Pregnancy Discrimination Act (PDA) of 1978, employers cannot discriminate against employees or job candidates based on:

Pregnancy
Childbirth
Related medical conditions

While employers cannot ask about a candidate’s plans to have children, they can ask about job-related requirements like travel or attendance—as long as these questions are asked of all candidates, not just women.

3. Paternity and Parental Leave Policies
While paternity leave is not required in the private sector, many companies choose to offer paid parental leave to attract and retain top talent.

Under the Family and Medical Leave Act (FMLA), eligible employees can take up to 12 weeks of unpaid, job-protected leave following childbirth. However, because FMLA leave is unpaid, many parents return to work sooner due to financial constraints.

Offering flexible parental leave options can strengthen company culture and improve employee retention.

Additional Resources

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