Pregnancy conditions your health insurance will and won't cover

Its important to remember that pregnancy isn’t a medical condition, it’s a natural process, and as such your insurer won’t cover you for anything related to a routine pregnancy. Your midwife will be able to advise you that some symptoms such as a change in your urinary flow rate and heartburn are common among pregnant women. While these symptoms can be unpleasant, they are to be expected among pregnant women and shouldn’t cause concern. Often over the counter medication can usually resolve the problem, and it will quickly go away once the baby has been delivered.

Serious complications only develop in a small number of pregnancies, and in this case your insurer will usually be happy to step in and offer private cover. However, this distinction between routine complications which are not covered, and abnormal pregnancy conditions which are covered, can be confusing.

In an effort to clarify things I’ve provided you with more information on conditions that are commonly related to pregnancy and will not be covered, and those conditions which your insurer will look to cover. It’s worth bearing in mind that your claim will always be assessed on an individual basis with your personal circumstances taken into account. As such these categories should be treated a guide rather a rule book.

Routine conditions that your insurer could regard as related to pregnancy

Pregnancy can sometimes cause you to develop related conditions. Whether or not these are covered by your insurer will depend on the extent to which they can prove the link. In some cases it’s extremely difficult to prove, they may require medical evidence and if this is not conclusive you may still be granted cover even if there is a doubt as to the legitimacy of your claim. So if you fight your corner you could find your claim going through.

However, generally when the following conditions and symptoms are experienced by a pregnant women they will be looked at closely by your insurer.

  • Haemorrhoids – Increased abdominal pressure and constipation can lead to the formation of haemorrhoids during pregnancy.

  • Varicose veins – As you gain weight during pregnancy there is increased vascular pressure which can lead to the formation of varicose veins.

  • Urinary frequency – During pregnancy you may feel the need to urinate more often due to the expansion of the uterus putting pressure on your bladder.

  • Gastroesophageal Reflux Disease – During pregnancy food spends longer in your stomach leading to an increase in heartburn.

  • Constipation – Your intestines adapt so they absorb all the nutrients they can from your food to aid your baby’s development. This process can lead to your faeces becoming dehydrated leading to constipation.

Your policy doesn’t cover you for any symptoms or conditions related to routine pregnancy, but will cover you for any serious complications you experience that are classed as “abnormal pregnancy”. These generally include the following:

  • Pre-eclampsia – This condition leads to a dangerous increase in blood pressure in around 6-8% of pregnancies. Treatment is essential in order to prevent development of the more serious condition known as eclampsia. Generally the only effective treatment is delivery of the baby by caesarean section.

  • Eclampsia – Eclampsia is characterised by seizures which can leave the mother in a permanent coma. The pregnancy must be terminated immediately, ideally via delivery.

  • Ectopic pregnancy – An ectopic pregnancy occurs where a foetus grows outside of the womb, such as in the fallopian tube. Generally such pregnancies are not viable and treatment is needed to terminate the foetus before the mothers life is put at risk.

  • Placental abruption – The placenta can separate from the lining of the uterus leading to loss of blood from the mother and distress from the baby. A speedy delivery is needed to prevent further damage to mother and child.

  • Deep vein thrombosis – Deep vein thrombosis occurs when a blood clot forms in a deep vein, usually in the leg. This can be dangerous as it may limit the return of blood flow to the heart. The common treatment given to sufferers is a course of anticoagulant drugs to prevent any further clotting. Compression stockings can also help with the condition.

So to summarise:

  • If you’re suffering from a routine side effect of pregnancy such as heartburn, you generally won’t be covered by your private medical insurer.

  • If you’re suffering from a condition that has developed during pregnancy such as varicose veins which could have been caused by the pregnancy itself, whether you are covered or not will depend on the extend your insurer can use medical information to identify a link. Usually these cases aren’t concrete and there is room to fight your corner.

  • If you’re suffering from an abnormal pregnancy such as pre-eclampsia, this is an acute condition so you should be covered by your medical insurance.

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