Pregnancy and Short Term Disability Insurance Benefits

Short Term Disability While Pregnant: What You Need to Know About Short Term Disability Benefits And Pregnancy

Having a short term disability policy can be a great way to supplement your income when you are out for maternity leave. There are always many questions regarding short term disability and pregnancy:

  • Can you apply for short term disability while pregnant?
  • Will you be approved for benefits while pregnant?
  • How much will my benefits be if I am approved?

Was the Pregnancy a Pre-Existing Condition?

This first thing to consider is (a) how long you were with the employer before taking leave for a pregnancy; (b) when the Short Term Disability coverage took effect; (c) whether you were pregnant before the STD insurance coverage took effect; and (d) whether there is a “pre-existing condition exclusion” in the short term disability policy.

It is very common for short term disability policies through employers to consider pregnancy a pre-existing condition. If there is a pre-existing condition exclusion and you were pregnant when the STD coverage took effect, you may not be eligible for STD benefits relating to a pregnancy until 12 months after the short-term disability coverage took effect.

Understanding this “pre-ex” issue is very important when determining whether to purchase short term disability insurance. You can still buy the policy, but you typically need to pay for it for a full year before you can use it for pre-existing conditions.

Applying for Short Term Disability Coverage

Most insurance companies will ask you a series of questions to determine your eligibility for the STD benefits. Usually, the question about pregnancy does not come up. You can still apply even if you are pregnant, but you will not be able to use your benefits until after the waiting period.

Waiting Period

As previously mentioned, many short term disability policies have a waiting period of 12 months; This means that your claim will be denied if you become disabled within the first 12 months due to a preexisting condition like pregnancy or childbirth. Believe it or not, you may have to provide a sonogram to prove your conception date.  Some insurance policies state that if you deliver a baby within nine or ten months of the policy effective date, they will deny the claim as well. They may request a copy of your child’s birth certificate to verify the date of birth.

Since most babies are born before their due date, it is wise to wait to conceive until you are beyond the period that can be deemed questionable by your insurance company.

Applying for Benefits

When you apply for benefits, women often find themselves in one of two categories:

Approved Claims: claims that occur after the effective date and the medical condition is not a pre-existing condition. This category includes illnesses due to cancer and heart disease, injuries, and pregnancy complications and childbirth.

Denied Claims: claims that occurred before the policy effective date or are otherwise noted as excluded from the policy in the policy language. This category includes pre-existing pregnancy/childbirth, illness, injury, or normal childbirth occurring within nine months of the policy effective date.

Five states currently have a mandatory state disability program that will cover women who register in time: California, Hawaii, New Jersey, New York, Rhode Island and Washington State (coming in 2020). Although these programs are mandatory, it’s still rare for women to qualify because most do not know about the programs until after they conceive.

Deciding to Purchase Short Term Disability Insurance

Even if you are pregnant, still consider purchasing a short term disability policy for future pregnancies. This policy can also cover you for things like a major accident or illness that’s not associated with your pregnancy.

Consider a voluntary policy through your employer. This type of policy covers what is considered to be a “normal” birth. A normal delivery is defined as a vaginal or cesarean birth. These policies also have an elimination period. The elimination period is the amount of time that you will wait to receive your first benefit check. Typically this is one, two, four, or six weeks after your claim is approved. The longer your elimination period, the lower your monthly premium will be.

Most employers who offer a voluntary policy have an open enrollment period during the Fall. Another benefit of this type of plan is that it is portable. You can take the policy with you if you choose to leave your employer.

There are several benefits to having a short term disability policy when you are having a baby. Timing is always key to getting the most benefit from your policy. Remember even if you are already pregnant, you can still qualify for the policy. You may not be able to use the policy for this pregnancy, but an illness, accident or future pregnancy would be covered after the waiting period.

Although normal childbirth is not covered under long term disability, if you experience complications during pregnancy or after birth, you may still be eligible for long term disability benefits.