Pregnant without health coverage

My wife is pregnant and we do not have health insurance, although I will soon have coverage through my job. Will I have to lie and pretend it is not preexisting, or am I faced with paying huge bills?

It is fairly easy to determine when conception occurred based on last menstrual period (don't give them a false date here because it is very important to date your pregnancy accurately) and uterine size from ultrasound, so it may not be prudent to mislead your prenatal care providers about when the pregnancy began.

Many women are faced with the dilemma of becoming pregnant with no medical insurance or switching jobs or plans when they are already pregnant. The following information comes from an organization called Consumer Insurance Guide: Insurance News Network. Their mission is to deliver accurate, unbiased insurance news for consumers. They offer tips, in-depth stories, and expert guidance on auto, homeowners, health, life, and business insurance, plus annuities. They are an independent news site that does not sell insurance and are not owned or operated by an insurance company.

Pregnancy complicates health insurance options. Federal law bars pregnancy from being considered a preexisting condition, which means if you change health plans while you're pregnant, your new insurer can't deny claims related to your pregnancy. But a variety of loopholes means pregnant women could still lack insurance coverage for their prenatal care if they don't do some careful planning.

Under a law known as HIPAA, the Health Insurance Portability and Accountability Act of 1996, health insurers cannot consider pregnancy a preexisting condition. So, unlike illnesses such as diabetes, they can't deny you coverage when you go from one job to another and switch health plans.

"It was not good public policy to have a pregnant woman with no access to health insurance," says Kansas Insurance Commissioner Kathleen Sebelius. "We want to encourage prenatal care and regular checkups during the course of a pregnancy and having pregnancy as a preexisting condition would block access to health care." There are exceptions to the rules, however.

Unfortunately, there are a lot of "buts" to HIPAA. For one thing, HIPAA doesn't apply to someone who previously had no health coverage at all and then gets into a group health plan through a new job. So if you had no insurance, got pregnant, then landed a new job with insurance, your new health plan would not have to immediately cover your pregnancy. You might have to sit out a preexisting condition waiting period, a period that could be longer than your pregnancy and in the meantime pay for your visits yourself.

Second, HIPAA applies only to group health plans. So if you have individual insurance and are pregnant, then buy group health insurance, you again could be subject to a preexisting condition waiting period. Likewise, if you move from one individual health plan to another individual health plan, you might not get pregnancy coverage at all. You might have to sit out a waiting period, or if you are offered insurance that covers your pregnancy, you might find it's very expensive.

"HIPAA is really the only protection against pregnancy being treated as a preexisting condition, and there are lots of people to whom HIPAA rules don't apply," Sebelius notes. Eligibility waiting periods are possible.

Here's another scenario. Say you have group health coverage and then switch jobs. Your new health plan has a one month eligibility period before it begins and you're pregnant. What can you do? "Probably nothing," Sebelius warns. The health plan isn't required to cover your pregnancy until the plan takes effect. While that might not be a problem if you're early in your pregnancy and you don't mind paying for a prenatal visit or two out of your own pocket, it could be trouble if you're in your eighth or ninth month and have no coverage.

If you find yourself without insurance, organizations such as Catholic Charities and Lutheran Social Service often have reduced cost prenatal services available.

Telling your boss you're pregnant: 5 things you need to know

You're expecting -- congratulations! But now comes the hard part: When do you tell your boss the big news, and how do you do it?

1. Do your research and know your rights.
As soon as you can, either before you get pregnant or soon after, research your employer's health plan and parental leave policy. You can do this by reading your contract or talking to someone in human resources, your company's personnel department or your union. Find out specifically what paid and unpaid leave you are eligible for. You might have some leave without pay that still includes benefits. Talk to other people who have taken family leave as well. They can give you information about your employer's policy -- both what it looks like in theory and in practice. If there are two employed parents, remember that dads are often eligible for family leave as well as moms.

2. Talk to your doctor.
It is useful to check with your doctor about when to make the announcement. Many people like to wait through the first trimester before they start telling family and friends. Your doctor may also have an opinion about how much time you should take off from work before and after giving birth, depending on your health.

3. Think about the kind of maternity or paternity leave you might like to take.
It is very difficult to imagine what life with a new baby will be like. Many people imagine that they will feel much the same as they do now about working, child care and spending time with baby. However, lots of people find their feelings change considerably once they become parents. As you prepare to talk with your boss about your pregnancy and its effect on your work, it is important that you try to imagine several different scenarios. This enables you to ask for what you want as clearly as possible, and it gives you and your boss a framework for creating as flexible a plan as you can. For instance, you could come up with a plan for returning in three months, six months, 12 months or 18 months. You might also want to consider coming back part-time after you leave, or working part-time at home (depending on your job).

4. Analyze your finances.
In order to give yourself as many options as possible, it is useful to think about your income, budget and expenditures. Imagine whether it would be possible to alter your lifestyle so that you could go without your income for several months -- or several years. Consider ways you might be able to reduce your income and increase your time at home by working part-time.

5. Arrange a comfortable time to talk with your boss.
Once you are informed about your company's policy and have thought about how much time you might want to take off, make an appointment to talk to your boss. Depending on your relationship with your boss and your company's policy, you may choose to write your boss a letter rather than talk to her in person. As well as telling your boss about your request for leave, it is also useful to discuss your long-term interest in working in the company. Some employers may be willing to give a generous maternity leave if they value you and feel like you are committed to your job.

Kids and Money

Leaching children the value of money is more difficult in today's cashless culture where checking accounts, ATM cards and credit purchases are part of everyday life. How do parents show kids the impact of everyday purchases on the family budget?

According to an online poll of 556 parents by Parent Soup, one of the largest parenting sites on the Web and America OnLine, 58% feel that school-age children and teens should be part of the family budgeting process, 32% feel that parents should not share family financial information with their children.

Those who voted "no" explained that they feel there are better ways to teach kids about financial responsibility and were worried that children not take on additional concerns in already stressful lives. Others feel that real life is the best learning experience of all, and include their children in making family financial decisions.

Here's what people had to say:

• Why in the world would you put added stress on your children about the family budget? Our children have grown up knowing that sometimes we have to wait until payday for purchases. That's as much of the financial situation that they need to know as children. That is what school-kids are -- children.
- meritt (Web)

• My family was poor when we were growing up but we never felt like we were going to end up on the streets. We did hear, "that's too expensive," and we wore second-hand clothes. We always felt secure about having a roof over our head and having warm food in our belly. It is important to teach children the value of money, but it isn't necessary to include them in the family budget.
- katnappy (Web)

• My kids have known about our finances since they were little so that they could understood why we couldn't do some things. My 18 year-old son has worked since he was 15. He has his own car, keeps up the maintenance and helps pay the insurance on it. He has learned how to handle his own money.
- CCMom41 (AOL)

• I think teens should be involved in family finances. My parents never told me anything, except that they were worried about money all the time. Because they sheltered me from it, I had no idea how much something was worth, how to spend my money or how to save it.
- LisaJane44 (AOL)

• My kids were such whiners about what they couldn't have! We finally sat down and showed them just where all of Dad's paycheck is going. I swear they thought we where hoarding millions somewhere. It made things a little better. They turn off the lights a little more and they think twice about making long distance calls. When they're old enough to understand, I think it's okay to show them where the money goes.
- Unamommer (AOL)

Whether you choose to include your children in discussions of the family budget or not, it's important to teach them that money really doesn't grow on trees!

The 5 Secrets of Raising Healthy Eaters

The mere thought of transforming your family from a junk-food-munching, meal-on-the-go-eating, inadequately exercising bunch into one that's, well, not those things can be pretty daunting. But you'd be surprised by the impact even the most minor changes can make, say James Hill, MD, and Susan J. Crockett, PhD, RD, FADA, authors of Betty Crocker's Win at Weight Loss Cookbook: A Healthy Guide for the Whole Family. They stress that healthy eating habits are family business ‑- and good habits start with the decisions you make. Read on for five manageable changes you can begin to make today ‑- sure to inspire independent, food-savvy young adults down the road.

Let them choose
With 16 percent of children ages 6 to 19 overweight or obese, weight management is a serious issue. In fact, new research from Harvard Medical School and the Children's Hospital Boston reveals that children 8 to 15 who are in the upper half of what's considered a normal weight range are more likely to become overweight or obese adults.

Dr. Hill and Dr. Crockett stress that raising healthy teens and adults starts young ‑- and with letting kids be responsible for their own food choices. "There's a division of responsibility," Dr. Crockett says. "Parents must start out by bringing healthy food into the home, but a child needs to be responsible for when and what he eats."

Why it works: Eventually kids will be selecting parts of their meals and snacks, whether at school or at friends' homes. Giving them the responsibility to do so at home (and making sure their choices are sound) will help them make the right decisions in other settings.

Stock smart snacks
Snacks are an inevitable ‑- and necessary ‑- part of eating for both kids and adults. Keeping healthy snacks on hand is beyond logical, but it's not enough to keep fruits and veggies stocked in the fridge ‑- you have to make them accessible and appealing to kids. Maybe you'll eat a whole apple, but your kids will only go for slices. They have to be easily available, says Dr. Crockett: on the counter, washed and ready to eat. While "treats" are okay (we'll get to that in a bit), be sure to always have healthy staples handy, such as whole grain crackers, yogurt, breakfast cereal and low-fat peanut butter.

Why it works: "People snack," says Dr. Hill, "and if you have bad stuff around, that's what gets eaten." Sometimes a hungry kid home from school will literally eat the first thing he sees, so better that be carrots and hummus than chips and dip.

Set sensible limits "I'm not a big fan of 'never,'" says Dr. Hill. However, realistic limits are important. Treating junk food as forbidden fruit makes it all the more likely kids will binge when they have free rein to do so, but you can stipulate the "how often and how much," says Dr. Crockett. Here are some things to consider:

• Buy treats, such as cookies and soda, in limited quantities and explain that when they run out, they run out. Don't replenish during every grocery run.
• Emphasize the idea of eating only when hungry by not offering up snacks unless your kids ask. (If they're hungry, they will!)
• Limit where snacks can be eaten ‑- e.g., not in the car or in front of the computer or TV.

Why it works: When you allow even the most indulgent foods on occasion, kids won't feel deprived. But when you set basic limits on what, when and where to eat, kids will learn they can't have it all and need to decide for themselves how to "budget."

Size up portions "It's a common mistake to overestimate portion sizes," says Dr. Crockett. She recommends using the "one tablespoon" rule for kids up to ages 9 or 10. Serve one tablespoon for every year of the child's age. So, for a meal that consists of carrots, meatballs and rice, a one-year-old would get one tablespoon of each, a three-year-old would get three tablespoons of each and so on.

Why it works: "If a child asks for more food, then give her more," says Dr. Crockett. But it's better to start with less, because you'll ensure that your child only eats when she's hungry and not just because something's on her plate.

Realize they are what you eat (and do)
Quite possibly the easiest and most effective change you can make stems directly from your actions. Guarantee that your kids will observe your good behavior with family meals and active outings. Family dinners are healthy in more ways than one: A new study out of Syracuse University found that the rituals and routines in family mealtimes help establish identity and are good for mental health too.

But in terms of actionable behavior, if you want your kids to stop drinking so much soda, you shouldn't guzzle down pop regularly either. Don't encourage playing outdoors while you're catching up on TiVo ‑- it's far more effective if you're running around with them.

Why it works: Kids are amazingly perceptive. While you're not expected to become a model eater overnight, start by making the same changes you expect of your kids. "You have the greatest ability to influence by what you do, not what you tell them to do," says Dr. Hill.