1. Lois Vega
Claim Story
During Open Enrollment for ACA in December 2000, one of the Headquarters’
Staff elected to sign up for Short Term Disability even though she was 4 months
pregnant. She understood that this pregnancy would not be covered, UNLESS, she
has a complication – which she did not expect would happen.
On February 5th, because of premature contractions, she was put on bed rest. Her
STD policy kicked in. She stayed on bed rest until April 15th
, when she had to have
an emergency C-Section because of pre-clampsia. Policy continued to pay. After
the C-Section, she acquired a wound infection – policy continued to pay.
So, for this insured who under normal circumstances, her pregnancy would not
have been covered, she received $4,504.04 because all events were considered a
complication and not a normal event to a normal pregnancy.