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Is Pregnancy a Qualifying Event?

Is Pregnancy a Qualifying Event?

Is pregnancy a qualifying event? Can an expectant mother be added to a group health plan as a dependent when she finds out about the pregnancy? When an employee finds out she is pregnant, these are often questions directed at HR. Find out if pregnancy is considered a qualifying event and how to answer other frequently asked questions from expectant mothers.

Questions About Insurance and Pregnancy 

A qualifying life event is a change to an individual’s circumstances that allows them to make adjustments to their benefits despite the time of the year. Typically, employees are only eligible to make adjustments during the company’s open enrollment period, which often (but not always) takes place towards the end of the year.

 

 

Is Pregnancy a Qualifying Event?

No, pregnancy is not considered a qualifying event in most states. However, giving birth to the child, adopting a child, or a foster child placement is considered a qualifying event

 

Is Pregnancy a Pre-existing Condition? 

According to the Affordable Care Act (ACA) pregnancy cannot be considered a pre-existing condition. So, if open enrollment occurs before the baby is born, the expecting mother can be added to the plan without fear of a pre-existing condition exclusion. The same would apply for a non-spouse in the event that the plan allows domestic partners. This means that all maternity costs would be covered by the policy, but they would still be responsible for any deductibles, coinsurance, and copays.

 

What Other Insurance Options do Pregnant Mothers Have? 

While pregnancy is not generally considered a qualifying event, there could be other options available. Women who meet the eligibility criteria for Medicaid or Children’s Health Insurance Program (CHIP) can enroll at any point during pregnancy. 


What Else Should Employers Know About Pregnancy? 

  • Remind employees what they need to know about qualifying life events. When an employee experiences a life event such as the birth or adoption of a baby or a marriage, chances are they’re not immediately thinking about how it impacts their insurance. However, because a newborn is considered a qualifying event, your employees are permitted to make adjustments to their benefits packages—including adding the child to their health insurance once the baby is born

     

  • Pregnancy can also come up during the hiring process. The Pregnancy Discrimination Act of 1978 made it illegal to discriminate on the basis of pregnancy, childbirth, or related medical decisions. You cannot ask about whether a candidate plans to have children, but you can ask if the candidate can meet job requirements, including attendance, travel or relocation—each of which could be affected by whether a candidate has children. But you can only ask these questions if you ask them to all candidates. If you are only asking these questions of women, you may be found to be out of compliance.
  • Paternity leave is not legally required, but it can serve as a retention tool. There is no federal legislation in the United States that requires private employers to offer partial or fully financially reimbursed parental leave. However, it is available for federal employees. With this said, robust parental leave policies can serve as a significant indicator of an organization’s company culture and can help boost other important human resources goals. 
  • On the other hand, the Family and Medical Leave Act (FMLA) requires up to 12 weeks of unpaid, job-protected leave for certain employees. While this is helpful legislation for many parents, mothers and fathers often return to the workforce before the 12-week period expires due to lack of pay. 

Employers looking to make changes to or update their paid parental leave policy can reference this communications template.

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