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Claim for coverage of abortion expense should be denied due to pre-exi


Guest Damien

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I have a claim in our office for abortion on a brand-new self-funded plan member who has no creditable coverage. I am inclined to say this is subject to the pre-existing exclusion, but the relation between abortion and maternity gives me pause. I don't want to run afoul of the pre-x rules regarding pregnancy.

Has anyone handled this situation before? I am wondering if the determination might hinge on the reason for the abortion.

Any help would be appreciated!

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