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Q: Health Insurance for Expat with Pregnant Wife in Mexico! ( Answered 5 out of 5 stars,   1 Comment )
Subject: Health Insurance for Expat with Pregnant Wife in Mexico!
Category: Health
Asked by: curiousjamie-ga
List Price: $100.00
Posted: 28 Mar 2006 18:18 PST
Expires: 27 Apr 2006 19:18 PDT
Question ID: 712963
OK, this is a doosie.

My wife and I just found out that she is pregnant, due in November.
Naturally, I would like to have my health insurance pay for her
pregnancy-related medical bills.

OK, so now it starts to get interesting.

Complication #1: We divide our time between Mexico City and New York
City and would like to have the baby in Mexico (where my wife is
from), provided we can get insurance that covers us down here at the
private hospital where she has an OBGYN she likes.

Ideally, we'd like to find an insurance plan that covers us in both
the US and Mexico, since my doctors are all in New York (where I'm
from). Also, my wife sees doctors in the US from time to time.

At the moment, I'm focused mostly on avoiding having to pay out of
pocket $10-30k (or more) for the pregnancy-related bills. We had a
baby in the US last year and the bills (which were almost entirely
paid for by my insurer) were huge. Of course, I'd prefer it if the new
plan was not too expensive (i.e., under $1000 a month; I pay $800 a
month now for the three of us). The co-pay amounts, and even monthly
premiums, are of secondary concern to me right now compared to
avoiding having to pay for the whopping OBGYN doctor and hospital

Complication #2: I have been insured via COBRA since Jan 1, 2005. My
previous employer used United Healthcare and so that's what we've been
using. United Healthcare seems to only offer coverage in the US
(except for life-or-death emergencies); furthermore, that's probably
moot since COBRA runs out after 18 months, in my case at the end of
June, five months before the baby is due.

This may or not be helpful or relevant but I am currently working at a
small company in New York that has a group health insurance plan with
Guardian Healthnet. I haven't signed up for it since I opted to use
United Healthcare via COBRA. I just checked and it appears that
Healthnet doesn't offer any insurance coverage outside the US, so I
don't think they can help me with insurance in Mexico.

I should also note that our company is planning to renegotiate its
health plan in May and since it's a tiny company I have some say over
what we end up with. Conceivably I could steer us toward a new
insurance company that offers some kind of international plan, if such
things even exist.

I need to figure this out soon since my COBRA-based insurance goes
away at the end of June!

My question is: is there a health insurance company that will 

a) insure us for less than $1000 a month 
b) cover our pregnancy bills in Mexico at a private hospital
c) also let us continue to see some doctors in the US

I'd be delighed to pay $100 if they can propose a solution to (a) and
(b); I'll throw in an extra $50 tip if your solution also gets us (c).

As part of your answer, I'd appreciate it if you could explain how
HIPAA (the Health Insurance Portability and Acountability Act) relates
to my situation. From my limited research, it seems like HIPAA says
that I can switch providers and have the new provider cover my wife's
pregnancy-related claims, so long as I move from one group plan to
another (is that true?). If that's the case, perhaps there is an
insurance company in the US (subject to HIPAA) that offers some kind
of global coverage that would work for us...?

Wow, that's a curveball of a question. If you can help me here I'd be
most grateful!!

Complication #3:

Request for Question Clarification by cynthia-ga on 29 Mar 2006 02:32 PST
The first roadblock is this:

Q: Does an International Medical Plan provide maternity coverage?
A: It depends on the plan you are choosing. Most comprehensive plans
can include maternity, however, most require that you satisfy a period
of eligibility (generally 6 to 12 months) before benefits will be

Figures they would call pregnancy a pre-existing condition.  Have you
considered this?

Clarification of Question by curiousjamie-ga on 29 Mar 2006 19:16 PST
Thanks Cynthia and Research-Help for considering my question,

I agree with your logic. From a business perspective, an insurance
company would not want to insure a pregnant woman. However, it seems
like Congress decided that as a matter of public policy insurance
companies cannot regard pregnancy as a pre-existing condition.
According to the DOL's website:

Under HIPAA, preexisting condition exclusions cannot be applied to
pregnancy, regardless of whether the woman had previous health

Assuming I'm reading that correctly, what I'm interesting in finding
out is whether there is an insurance company that is subject to HIPAA
which covers treatment in Mexico (and, ideally, also treatment in the
Subject: Re: Health Insurance for Expat with Pregnant Wife in Mexico!
Answered By: wonko-ga on 01 Apr 2006 16:44 PST
Rated:5 out of 5 stars
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  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)

"Global Citizen FAQs" Highway to Health (2006)

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
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:

"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

"Frequently Asked Questions" CIGNA International Expatriate Benefits

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

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.



Search terms: "Group health plans" eligibility; international medical
insurance HIPAA; expatriate health insurance HIPAA; HIPAA pre-existing
curiousjamie-ga rated this answer:5 out of 5 stars
I don't know if this will work -- as you say, this is frought with
multiple challenges -- but I appreciate that you dug into this issue
and clearly did a lot of work to propose these potions. I'll let you
know if these suggestions pan out!



Subject: Re: Health Insurance for Expat with Pregnant Wife in Mexico!
From: research_help-ga on 29 Mar 2006 07:20 PST
Insurance is meant to manage risk, not to pay your upcoming bills.
Since you are already pregnant, most companies will consider this a
preexisting condition.
Further, insurance companies are around to make money. How could a
company collect less than $1,000 a month from you and pay tens of
thousands of dollars in health care costs and still make money?  So,
from a logic standpoint, you are in a very difficult situation.

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