Private short-term disability insurance during pregnancy takes the financial worry out of complications that occur before delivery. You doctor may order you to stop working as early as your first trimester.
Voluntary short-term disability insurance during maternity leave covers mom’s recovery from normal labor and delivery. The very same policy can extend benefits if she delays her return to the job because of postpartum problems.
Follow this four-part outline to learn about two valuable but very different forms of coverage.
- Requirements to complete prior to conception
- Rules for purchasing coverage providing maternity leave pay
- Valid medical reasons for claims during pregnancy
- Determining the length of pregnancy and maternity leave
Short-Term Disability Pregnancy Requirements & Rules
Women often find discover the short-term disability insurance for pregnancy eligibility requirements and related rules very confusing. It is important to begin before pregnancy, choose the best elimination period, pick the right form of coverage, and complete the appropriate paperwork.
Buy Before Pregnancy
The most important requirement for short-term disability insurance occurs before pregnancy. The requirement has three parts.
Apply for a maternity leave loan to obtain immediate funding. We often find that this three-part eligibility requirement excludes most site visitors. Obtain the extra cash needed to spend time at home bonding with your baby. Borrow money only if you are certain that you are returning to work quickly.
- Buy the coverage before you conceive. A new policy will only cover accidents, unrelated illnesses, and future gestations. It does not matter that the pregnancy was unplanned, only 6 weeks along, or any other point in the first trimester.
- Plan to deliver early. Many policies exclude normal childbirth that occurs within nine months of the effective date. Women carrying twins and higher order multiples often deliver preterm. Therefore, buy the policy several months prior to conception to avoid this pitfall.
- Expect delays in the process. The most attractive option requires purchase through your employer. You may need to ask them to offer a voluntary option. This takes time. Therefore, begin the process a year before conception.
Elimination & Waiting Period
The rules for the short-term disability insurance elimination and waiting period are especially important during pregnancy. The elimination period (also referred to as the waiting period) determines how long benefits are not payable for a loss.
Request a short-term disability pregnancy quote. Ask the agent to illustrate how the elimination period choices affect premium costs and projected benefit scenarios. Learn these critical elimination period rules and definitions before proceeding.
- Applicants determine the elimination period when first purchasing coverage. Longer elimination periods come with lower premium costs and vice versa.
- Longer elimination periods reduce the benefit received. For example, the standard benefit for normal childbirth is 6 weeks on voluntary plans.
- A plan with a 3-month elimination period pays nothing.
- A plan with a 1-week elimination period nets 5 weeks of benefit.
Social security disability has a five-month elimination period (which they refer to as a waiting period). Therefore, Social Security rarely covers pregnancy-related losses – as they are temporary in nature.
People frequently conflate the term waiting period to a common pregnancy-related exclusion clause in most contracts. Women want to know how long after the policy effective date do they have to wait before getting pregnant. Most plans exclude benefits for normal childbirth when mom delivers within the first nine months. As explained above, it is best to wait at least 3 months – just in case your baby delivers early.
Another important short-term disability pregnancy requirement relates to the forms of coverage and the paperwork you must complete for each.
Individual short-term disability insurance for pregnancy comes in two forms. Each form has unique benefits. Pay close attention to this important distinction. Read more about each form in the purchase rules section.
- Private policies bought outside of employers do not cover mom’s recovery from childbirth.
- Voluntary policies paid by employees through work do cover mom’s recovery from childbirth.
The paperwork that women must complete varies based on the form of coverage and the stage in the process. Expect to complete some of this paperwork.
- Claims paperwork submitted to the insurance company after a valid loss.
- New account paperwork enables an employer to offer a voluntary option.
- New policy paperwork commences the request for coverage.
Rules for Buying Short-Term Disability for Maternity Leave
Pay close attention to the rules for buying short-term disability insurance for maternity leave. The choice you make for where you purchase the policy and how you pay the premium will have a profound impact on the level of income replacement you enjoy while bonding with your baby.
Not every short-term disability policy covers maternity leave – while mom recovers from labor and delivery after normal childbirth. Learn these purchase rules before buying.
Voluntary Maternity Leave Pay
If your employer does not offer short-term disability for maternity leave, ask your boss for a voluntary program. Employees pay the premium. Employers bear no direct cost in offering paid maternity leave benefits to female employees.
- Voluntary short-term disability insurance for maternity leave covers mom’s recovery from normal childbirth. Women purchase voluntary policies at work and pay the premium themselves using payroll deduction. These are individual plans owned by the employee. They are portable. This means that if you get a new job or change employers while pregnant, you can keep the coverage in force.
- Private plans that you can purchase outside of employers do not cover mom’s recovery from normal childbirth. They do not create maternity leave pay. However, it is a convenient option that works well for women concerned about missing significant time before the birth of her baby.
Maternity Leave Taxes
When you purchase a plan at work, short-term disability insurance maternity leave taxes become a crucial topic for two reasons. Taxation alters the cost-benefit equation and indirectly answers a very common question about canceling coverage after having a baby.
The rules for taxation of the claims payments are as follows.
- When you pay the premiums with after-tax dollars, the benefit is tax-free.
- If you pay the premiums with before-tax dollars, the benefit is subject to taxation.
- When your employer pays a portion of the premium, a proportional amount is taxed.
The expected maternity leave benefit for normal labor and delivery is often several multiples of the annual premium. Most couples prefer paying taxes on the smaller amount of income. This means that after-tax contributions maximize the value.
After-tax payment of premium also allows the owner to cancel the policy at any time outside of an open enrollment. Many women choose to cancel coverage shortly after receiving their claims check in the mail.
Short-Term Disability Pregnancy Valid Medical Reasons
It is also important to understand the valid medical reasons for taking short-term disability insurance during pregnancy. The policies do not automatically cover everything. However, when they do, mom can rest at home without the financial pressure to return to work before giving birth.
Apply for benefits by completing a claim form. Each insurance company adjudicates claims differently. Every policy contains unique language definitions for valid medical reasons. The information found below is not a promise to pay any claim.
Short-term disability insurance covers pregnancy-related complications that prevent the policyholder from performing the duties of her full-time occupation. Approximately 25% of women experience a qualifying medical event before giving birth (maternity leave, due date, or delivery).
However, not every pregnancy complication is automatically a valid medical reason.
Bed rest is not a valid medical reason by itself. Your doctor’s note for bed rest must describe the medical condition preventing you from being able to perform your primary job duties.
- Carpal tunnel syndrome must impede the performance of your primary job duties
- Exhaustion by itself does not meet the standard
- Gestational diabetes rarely interferes with job duties
- Lower back pain can impede lifting or standing for long periods
- Sciatica also impedes sitting or standing for long periods.
- Miscarriage (pregnancy loss) may require recovery at home
- Morning sickness must be very severe and continue daily for weeks
- High-risk pregnancy alone does not qualify unless combined with a specific medical condition
- Stress or anxiety are mental conditions and rarely covered
- Preterm labor may be eligible after satisfying the elimination period
Denials & Appeals
Denials are a frequent reality for short-term disability insurance for pregnancy. Writing an appeal letter can sometimes help. However, with most things in life, it pays to be proactive and prepared.
Insurance companies deny both applications for new coverage and claims for benefits on existing policies. These are the most common denial reasons, and suggestions for an appeal letter– if any.
- The person is too unhealthy to qualify for a new policy. Applicants must show evidence of good health. File an appeal using updated medical records – if applicable.
- Unemployed people do not qualify for a new policy. Applicants must be actively working and earning an income in order to purchase new coverage. An appeal is unlikely to help.
- Part-time employees must be very careful when purchasing a new policy and when filing a claim for benefits. Read the contract legal language carefully and keep detailed hours-worked records if filing an appeal.
- All carriers will deny new policies to part-time workers based on hours worked per week. Each has unique criteria.
- Many full-time women shift to working part-time before their due date. Some carriers deny claims from part-time insureds who once worked more hours.
- Insurers will deny all claims for benefits for any pregnancy-related loss when conception occurred prior to the policy effective date. File an appeal if the medical condition is not pregnancy related.
- Mom delivers her newborn within 9-months of the policy effective date. This falls inside the exclusion period and results in a claims denial. File an appeal showing evidence that conception occurred after the effective date, and that the delivery time was abnormal (premature).
Length of Pregnancy Disability and Maternity Leave
The length of time (number of weeks) that short-term disability insurance pays benefits is variable during pregnancy and maternity leave. There is no simple answer to “how many weeks does it last?” Every person’s situation differs. In addition, the features of each policy matters.
This chart provides a quick overview for the details found in the sections below.
|Before birth||1 – 30 + weeks||1 – 30 + weeks|
|Recovery from delivery||0 weeks||6 – 8 weeks|
Length of Disability Leave
The length of short-term disability during pregnancy leave (before birth) depends on the duration of the medical condition, and the policy features. Both private and voluntary plans work in a similar fashion.
- Duration of medical condition – Claims payments can last for as many weeks as the doctor’s note indicates you are unable to work. This means that a woman could begin her leave early in her pregnancy. In theory, a first-trimester disability could continue for up to 30 weeks or longer – provided a valid medical reason causes the loss.
- Policy features – Plan designs often vary widely and can impact the number of weeks of combined pregnancy disability leave (complications before delivery) plus maternity leave (recovery from childbirth and/or postpartum complications).
- Plans with short benefit periods (3 months) stop paying claims after 13 weeks
- Plans with long elimination periods minimize the number of weeks benefits last
Length of Maternity Leave
The length of short-term disability maternity leave after normal childbirth depends on the form of coverage, type of delivery, the possible continuation of a recurrent disability claim.
- Only voluntary plans cover mom’s recovery from childbirth and create maternity leave pay. works as follows. Most plans will replace up to 2/3 of your gross monthly income.
- The voluntary contracts pay benefits for a fixed length of time after normal childbirth.
- 6-week cash payment for vaginal birth less the elimination period
- 8-week cash payment for C-section delivery less the elimination period
- A recurrent disability does not need to satisfy the elimination period a second time. If the contract began paying benefits before delivery, mom receives the full 6 or 8 weeks of payments.
Reasons to Extend
Medically based postpartum problems are the most common reasons to extend short-term disability insurance for maternity leave. Having a baby is a high-risk activity. Things do not always go the way you envision. You may be injured during delivery, or develop an infection.
The main disorders that might affect you after a vaginal delivery include fissures, infections, and postpartum hemorrhage. The leading risk factors include:
- A baby weighing more than 9 pounds
- Use of forceps or vacuum
- Repair of large episiotomy tear
A delivery via C-section is a relatively safe surgical procedure but entails a higher risk of complications as it is far more invasive. The most common disorders associated with this surgery are blood clots in your legs or lungs, anesthesia-related nausea, and bowel movement problems (ileus).
Many new mothers experience postpartum depression after delivery. You may experience feelings of extreme sadness. A variety of factors can cause this change in mood.
- Changes in hormone levels
- Lack of sleep
- Changes in relationships
Short-term disability for postpartum depression is rarely covered. Check your legal language to see if it excludes mental disorders. Many do not consider postpartum depression or stress as a valid reason to extend maternity leave benefits.
Returning to Work
Your plans for returning to work do not extend short-term disability maternity leave benefits. Medical necessity determines the length of claims payments. They continue as long as your doctor indicates you are unable to perform your full-time duties, or the payment period ends.
A choice to stay at home longer is unrelated to your medical condition. You can choose to return to work long after recovering physically. However, your policy may no longer make claims payments.
The same holds true for women not returning to work after maternity leave. The policy makes claims payments while you are physically unable to perform the duties of your full-time occupation. Your plans to quit the job do not affect benefits.