How much does short-term disability pay during pregnancy? Is bed rest a valid medical reason? What types of prenatal complications qualify for a claim? How long do payments last after childbirth?
You have come to the right place if you are asking any of these questions.
The answers depend on the features you select at enrollment, the purchase timing, and whether you have one of three basic policy types.
Valid Reasons: Short-Term Disability Pregnancy
The valid medical reasons for short-term disability for pregnancy claims vary by the policy type. The three basic policy types offer a unique combination of coverage for expectant women who must stop working.
- Private plans purchased outside of employers cover the fewest conditions
- Voluntary policies bought at work by payroll deduction rest in the middle
- Group coverage paid by employers offers the broadest coverage
The three policy types help explain the most common reasons for denials and approvals.
Approvals During Pregnancy
Buying a policy before conception is the best way to get a short-term disability claim approved while pregnant. Add a few months of cushion to avoid having to prove that conception occurred after the effective date.
Request a short-term disability quote to start the process prior to conception. You can still buy a new policy while expecting. However, the company will not approve any pregnancy-related claims until 12 months after the effective date.
Early Pregnancy Bed Rest
A short-term disability claim approval during an early pregnancy bed rest can relieve some financial pressure. However, many parents may need extra help. A prescription for bed rest in the first or second trimester could mean months of lost income. Mom then needs 6 to 8 weeks to recover from her labor and delivery.
A lengthy maternity leave raises significant financial challenges.
- FMLA job protections expire after only 12 weeks if covered at all
- Small payout percentages translate into large cuts in take-home pay
- Unreimbursed medical expenses for doctors and hospitals add up quickly
- Social security does not cover temporary medical conditions
All three basic short-term disability policy types cover physical pregnancy-related complications that prevent a woman from performing the duties of her full-time occupation. Approximately 25% of women experience a qualifying medical event before giving birth.
Every doctor’s note should include the valid medical reason behind the pregnancy complication. The cause should reference a covered sickness. Covered sicknesses mean an illness, infection, disease or any other abnormal physical condition.
Below are examples of covered sicknesses that a doctor could include on a note or benefit application form. Keep in mind that the issuing insurance company makes the final claim approval decision.
- Anemia must be severe with clear deficiencies of iron, folate, or vitamin B12
- Carpal tunnel syndrome must impede the performance of your primary job duties
- Exhaustion by itself does not meet the standard
- Ectopic pregnancy often requires home recovery
- 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 may require recovery at home
- Dilation and curettage (D&C) has a very short recovery period
- Morning sickness must be very severe (Hyperemesis Gravidarum)
- Preterm labor may be eligible after satisfying the elimination period
Reasons for Denial
The three types of short-term disability policies for pregnancy have universal reasons for denial of claims. The two biggest causes of denied or delayed claims are buying after conception and using vague wording on the doctor’s note.
Buying short-term disability after conception is the number 1 cause for declination of a maternity leave-related claim. Most policy types exclude coverage for pre-existing conditions for at least 12 months.
Some group plans will waive the rule for newly hired employees. However, this applies to a very small number of people and companies.
Completing the short-term disability paperwork incorrectly is the second universal cause for a denied claim. For example, the doctor’s note should avoid the use of these three vague terms.
- Best rest by itself does not qualify. The doctor’s note must state the medical reason you must rest at home in bed rather than work.
- High-risk pregnancy also does not meet the standard. The doctor’s note must state the medical reason you are unable to perform your regular work duties.
- Twin pregnancy also does not fit the requirements. The doctor’s note must indicate what medical problem the twins or triplets cause.
Anxiety and Stress
Only group short-term disability covers pregnancy-related anxiety or stress. Private and voluntary policies do not consider any mental health disorder as a valid medical reason to support a claim.
Antepartum women in the workforce often experience physical and emotional stress that may affect her health. Stressors may include lifting, standing for long hours, excessive overtime, interpersonal conflict, and more.
If your policy does cover mental disorders, the doctor’s note must be very specific about how anxiety or stress is hurting the health of mom or her baby.
The best short-term disability maternity leave insurance covers childbirth after a normal pregnancy. Even when mom and baby are both perfectly healthy, the mother needs time to recover from her routine labor and delivery.
- Vaginal childbirth pays a 6-week benefit
- C-section delivery pays an 8-week benefit
This is a very popular feature as most women experience an uncomplicated pregnancy and labor. However, only 2 of the 3 basic policy types consider normal childbirth as a valid claim reason.
Private plans do not cover mom’s recovery from normal childbirth. Policies bought outside of the worksite cannot pool risks with other employees. Therefore, they exclude coverage for this high-probability claim.
Postpartum problems are the most common reasons to extend short-term disability for maternity leave. The insurance companies are far more likely to approve claims for physical (somatic) post-delivery issues than they are for emotional problems.
A mother’s plans to quit or not return to work should not affect any postpartum extension request. The carrier’s pay claims based solely on a person’s ability to return to the job. Intentions do not matter.
Most short-term disability plans approve claims for postpartum disorders that derive from physical problems. 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 somatic 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).
Short-term disability for postpartum depression qualifies more frequently with group policies. Coverage for this emotional disorder is rare with private and voluntary plans. Check your legal language to see if it excludes mental disorders.
Many new mothers experience postpartum depression after delivery. She 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
Pay Percentage: Short-Term Disability Pregnancy
The short-term disability pregnancy pay percentage differs for every person. The payment rate and schedule depend on the policy features, and the length a time a woman must stop working, and her regular earnings.
The pay rate is always less than 100% of your ongoing gross income. The policies provide partial income replacement. In other words, women face a pay cut in combination with extra baby expenses. Calculate your payment rate using these four factors.
- Benefit amount
- Elimination period
- Benefit period
- Tax implications
The short-term disability benefit amount is the first variable in estimating the pregnancy payout. Each policy has two limits that determine the percentage of income replacement. Most people choose these amounts at the time of policy application – when they enroll.
- 66% to 70% of weekly gross income
- $5,000 to $7,500 maximum weekly amount
The lower of the two limits always applies. Women in the higher income brackets face a larger pay cut.
The short-term disability elimination period affects pregnancy payments. The elimination period describes how quickly payments begin after a qualifying loss. Once again, most people choose the elimination period at the time of policy application – when they first enroll.
The elimination period always reduces the effective income replacement rate. Longer periods have a bigger effect than shorter ones do.
This chart calculates the possible impact of common elimination period options. In this example, a policy has a stated 66% income replacement level. This net result pertains to an expectant woman who stops working for 24 weeks (168 days).
|Elimination Period||Payout Percent|
The short-term disability benefit period also affects the pregnancy payment rate. This feature describes how long the policy will continue sending claim checks while the woman remains unable to work. Once again, most people choose the length at the time of policy application – when they first enroll.
The benefit period can reduce the effective income replacement rate. This happens when the time away from work exceeds the length limit.
This chart calculates the possible impact of common benefit period choices. In this example, the policy with a stated 66% income replacement level has a 7-day elimination period. The net result applies to the same expectant woman who stops working for 24 weeks (5.6 months).
|Benefit Period||Payout Percentage|
The taxation of short-term disability also affects the income replacement rate for pregnancy-related claims. A portion of the claim check may be taxed or untaxed. It depends on how the person pays the premiums.
A taxed benefit keeps the effective pay percentage the same.
- The employee pays premiums using pre-tax payroll contributions
- When the employer funds the premiums
An untaxed benefit sharply increases the effective payment percentage. This happens because you are comparing the claim amount to a smaller figure. The claim check is income tax-free when the policyholder funds the premiums with after-tax dollars.
Labor and Delivery Recovery: What Policies Cover?
Short-term disability maternity leave insurance has three unique policy types. Each category offers a unique combination of coverage, access, and premium cost to the covered person.
There is no best policy choice, as many people have only one option. Learn the pros and cons of each alternative and find a sample of companies in each of these three basic markets.
- Private plans bought outside of employers
- Voluntary plans purchased at work by employees
- Group coverage paid by employers for workers
Private short-term disability bought outside of employers may cover pregnancy complications. Since 25% of expectant women must stop working prior to delivery, this is valuable coverage.
However, private plans do not cover maternity leave for normal childbirth. Private policies will not make claim payments during the time mom is recovering from her labor and delivery.
Below is a sample listing of companies in the private market.
|Combined Insurance||Mutual of Omaha||Met Life|
|State Farm||United Healthcare|
Voluntary short-term disability bought at the worksite is ideal for maternity leave. Women can get the coverage they covet. Employers can offer the option without adding to direct costs.
Voluntary plans do cover mom’s recovery from labor and delivery in addition to her somatic pregnancy complications. Women own the coverage and can keep the policy in force wherever she works.
Employees pay the premiums for voluntary personal policies. Employers must support a payroll deduction. Supporting a payroll deduction has a minimal direct cost to the company. Here are the requirements.
- Subtracting the premiums from paychecks
- Forwarding the funds to the insurance carrier every month
- Notifying the carrier about changes in deductions
Ask your employer to offer a voluntary maternity leave insurance option if they do not already do so. Below is a sample listing of companies in this market.
|Humana||Reliance Standard||Sun Life|
Group short-term disability for maternity leave offers better benefits. The group plans often include coverage for mental health and normal childbirth. A large number of people participating in the plan allows the insurance company to pool risks and cover more conditions.
Be careful to verify group coverage with the companies on this list.
- Many people do not have access to group coverage. Employers must pay the premiums. This direct cost makes it expensive for companies to offer this program to personnel.
- Many people mistakenly assume they are covered. These carriers offer group policies covering other things. A payroll deduction listing one of these carriers could mean something different.
Many health insurance companies also offer group short-term disability plans covering maternity leave. Some do not. Employers decide whether to offer traditional medical insurance combined with a disability plan from a single carrier.
|Aetna||Blue Cross Blue Shield (BCBS)*||Cigna|
*BCBS is a network of affiliated carriers. Not every BCBS affiliate offers income protection.
**Tricare does not appear to offer disability coverage to uniformed service members.
Many life insurance companies also offer group short-term disability plans for maternity leave. Verify that you have both forms of coverage. It is not automatic.
|Liberty Mutual||Lincoln Financial||Metlife|
|Prudential||The Standard||The Hartford|