As you are aware, there are multiple challenges associated with your
request. You are correct that if your wife is covered by a new HIPAA
compliant health insurance policy, then the pregnancy expenses would
be covered. The problem arises in that you have to find a HIPAA
compliant health insurance policy that will both accept your wife
given as she is pregnant, provide benefits for pregnancy, and provide
coverage in Mexico.
I have identified two possibilities, although there are potential
issues with both. First, I cannot guarantee that a specific doctor
and hospital in Mexico City would be covered by either of the plans.
You would need to research that with the individual insurance
companies directly.
Second, as the other researcher and user have pointed out, most
international medical insurance plans are not HIPAA compliant, and
many do not cover pregnancy or impose conditions for benefits that
your wife's current pregnancy will not meet. International medical
insurance plans for individuals also are usually subject to
underwriting requirements, resulting in either rejection of the
application, pre-existing conditions being excluded from coverage, or
the imposition of hefty surcharges.
I have located one individual international medical insurance plan
that is HIPAA compliant (in fact, it advertises that it is the only
one: "Global Citizen" Highway to Health
http://www.hthtravelinsurance.com/glCitizens_plans.cfm). However, it
is medically underwritten. If they accept your wife, they will have
to pay for the costs associated with pregnancy, but they can either
raise the premium to compensate or not accept her application. Given
the high costs of pregnancy, particularly since you are interested in
retaining health care coverage in the United States, there is a
significant risk she would be rejected. If you opted for only
international coverage, where medical costs are generally much lower,
there may be a better chance that she would be accepted, albeit at
what is likely to be a much higher premium. Note that you would need
to be living abroad for the purposes of your application since the
plan is not available in New York.
"Will my pre-existing condition be covered under a Global Citizen plan?
Global Citizen is administered using HIPAA guidelines. If you were
previously covered by an annually renewable U.S. health plan that
issues you a Certificate of Creditable Coverage, HTH Worldwide will
credit you for this prior coverage. The number months of coverage
shown on the Certificate will reduce or eliminate the six-month
pre-existing condition waiting period. If you have six or more months
of creditable coverage, your waiting period will be eliminated. If you
have less than six months creditable coverage, your waiting period
will be reduced by the number of months you had creditable coverage.
For example, if you have two months of creditable coverage, your
waiting period will be reduced from six months to four months.
Am I guaranteed to be issued a Global Citizen policy if I apply?
No, Global Citizen is not a guaranteed issue plan. Each application is
medically underwritten. Your application may be 1) accepted, 2)
accepted with a rate increase due to your health status, or 3)
denied."
"Global Citizen FAQs" Highway to Health (2006)
http://www.hthtravelinsurance.com/prdCobrand/gl_citizen/faqs.cfm
The best chance you have of accomplishing your goal would be for your
employer to take out group international medical insurance that covers
pregnancy in the United States and Mexico. Group plans are typically
"guaranteed issue," meaning they have to accept every eligible person,
so being HIPAA compliant would guarantee that the pregnancy would be
covered. I have found one group plan that may meet your needs: CIGNA
International Expatriate Benefits
(http://ciebinq.intl.cigna.com/us/members/about_us/AboutUs.html).
They claim to operate the largest expatriate group health care
benefits business in the world. For additional information, CIGNA
International Expatriate Benefits provides a list of contacts for
sales representatives here:
http://ciebinq.intl.cigna.com/us/general/ContactUs.html.
"What is Pre-existing?
A pre-existing condition is an injury or sickness for which a person
receives a diagnosis, treatment or incurs expenses from a physician
within 90 days prior to the date a person begins an eligibility
waiting period or becomes an insured, which ever date is earliest. A
person that was previously covered under a plan which qualifies as
creditable coverage will receive a reduced pre-existing limitation
period under the new CIGNA policy, provided that the employer was
notified about the previous coverage under a prior plan and fewer than
63 days have elapsed between the coverage under the prior plan and
coverage under the CIGNA plan. The pre-existing condition limitation
period will be reduced by the number of days of prior creditable
coverage."
"Frequently Asked Questions" CIGNA International Expatriate Benefits
(2006) http://ciebinq.intl.cigna.com/us/members/faqs/FAQs.html#20.
In conclusion, the easiest way for you to ensure that the pregnancy
will be covered would be to switch to your employer's plan when your
COBRA coverage ends and have the baby in the United States. You can
certainly try to obtain individual international health insurance, but
I would be surprised if your wife can get it, and even if she could,
it would probably be prohibitively expensive. The other possibility,
which is more likely to be successful, would be to have your employer
acquire group guaranteed issue international health insurance that is
HIPAA compliant and would cover your spouse during pregnancy.
Ensuring that a specific plan would cover the doctor and hospital you
would like to use in Mexico City would present an additional
complication.
To ensure that you have health insurance coverage, I would definitely
switch to your employer's plan at the end of June when COBRA ends
unless your wife has been accepted by an alternative insurer by then.
Otherwise, if your wife goes more than 63 days without health
insurance, a new insurer can deny pregnancy benefits as a pre-existing
condition under HIPAA.
Sincerely,
Wonko
Search terms: "Group health plans" eligibility; international medical
insurance HIPAA; expatriate health insurance HIPAA; HIPAA pre-existing
conditions |
