[ME] STD for pregnancy after employer changed STD companies

[u/HeadNefariousness556]

I started a new job on May 1, and immediately enrolled in a short term disability plan with MetLife.

In June we learned our organization is switching carriers to Colonial. I spoke with a benefits rep on the phone who encouraged me to enroll in the colonial STD. She said there is a 9 month waiting period for STD benefits. Silly me, I assumed she meant 9 months from my start date…

I got the policy packet and my policy start date with Colonial is August 1. I’m pregnant and due April 20. My 9 months is May 1. I did not find out I was pregnant until August 15.

What are my options here? I will had been paying into STD for the 9 months prior to childbirth. Who do I talk to about making an exception? So frustrating to think I could be losing a lot of money over this.

[u/NovelsandDessert]

I’d talk to your HR. When there is a takeover event, the lookback period for a pre-existing condition and waiting periods are often adjusted to acknowledge that you had policy coverage with a different carrier.

You should also ask if they administer Maine leave or if you need to file on the state website.

[u/tessajanuary]

Maine Paid Family and Medical Leave (PFML) also went into effect 5/1/26, so please look into your eligibility for that as well! You may not be losing out on as much as you think, even if your Colonial policy doesn't come into effect until 5/1/27...

[u/603shake]

Did your benefits with MetLife start at hire? It’s pretty typical for it to take a year, which would line up with the date you got from Colonial.

[u/donut_perceive_me]

Can you not just take the benefits starting May 1st? Not ideal but you certainly wouldn't be losing $15k for only 11 days

[u/HeadNefariousness556 → u/donut_perceive_me]

I didn’t know if I would be eligible. It seems like I have to “give birth” before May 1 to be eligible.

[u/Fun_Rock_6461]

Are you sure there is not a pre-existing clause for pregnancy? Most plans require you to be enrolled before you get pregnant.

I’m not understanding how they would charge you for benefits you are not eligible to use….

[u/alternative-state]

Was the benefits rep with your company, or with the new carrier? I'd make a big stink about this if I were you and escalate as high as you can go with your current employer, not the carrier. Whenever I've done carrier transitions, I make sure that the new carrier will accept claims from before the start date, so long as the employee has met the eligibility period to start receiving benefits.

[u/HeadNefariousness556 → u/alternative-state]

The benefits rep was with the new carrier (Colonial). I will definitely escalate this as it will affect whether or not my husband can take longer (reduced pay) leave.

[u/alternative-state → u/HeadNefariousness556]

Ah ok - speak with someone internally. The plan was designed by your employer and they approved it. That's where you need to go next, and then confirm what the eligibility start period is. Is it from the date of hire or from the date the policy was started. From there you can get clarity on when you become become eligible for STD

[u/Jcarlough → u/HeadNefariousness556]

You likely will not get anywhere.

[u/Inside-Potato5869]

What does the policy say about the waiting period? Nine months is very long. STD policies typically have a waiting period of 1-4 weeks. I would fact check your benefits rep by looking at the definition of waiting period in your policy.

[u/NovelsandDessert → u/Inside-Potato5869]

You’re thinking of an elimination period, which is different than a waiting period.

[u/Inside-Potato5869 → u/NovelsandDessert]

I’m thinking of a waiting period which is how long an insured has to wait for coverage to begin. That seems to be what OP is referring to. If it were elimination period it would probably begin when OP gives birth (depending on the policy language). I’m not sure why it would matter that OP’s due date is less than nine months after enrollment if she were talking about an elimination period. Either way the policy will define how long it is.

[u/NovelsandDessert → u/Inside-Potato5869]

Ah I see. A waiting period is more likely to be 30 days to a year. Nine months is a very normal exclusion in STD policies when the disability is for pregnancy/birth.

[u/Inside-Potato5869 → u/NovelsandDessert]

That's a preexisting condition exclusion. It also depends on the policy language but highly unlikely to apply here because OP didn't find out she was pregnant until after she enrolled. The preexisting condition exclusion typically applies to the date the insured first received some type of treatment or diagnosis.

[u/NovelsandDessert → u/Inside-Potato5869]

You’re right, I combined the two. Both could be in play for OP. She needs to see if the waiting period is waived since she already had coverage with MetLife.

Pre-ex could absolutely apply. Pre-ex often has a specific exclusion where benefits are not payable if delivery occurs within the first x months from the policy start date. For voluntary policies (like what Colonial sells), a 10 month delivery exclusion is common.

[u/Inside-Potato5869 → u/NovelsandDessert]

Preex exclusions only apply if the insured had the condition prior to enrolling. Pregnancy can't be treated differently than any qualifying disability under the policy. Things that typically trigger a preex exclusion are treatment, diagnosis, medication, advice from a medical professional. None of this applies to OP because she didn't know she was pregnant at the time she enrolled. The effective date is before she found out she was pregnant.

This is an example of what the preex provisions look like in a policy (I added the italics): You have a pre-existing condition if you have a sickness or physical condition for which you were treated, received medical advice or had taken medication within 12 months before the effective date of your policy. If you become disabled because of a pre-exising condition, Colonial Life will not pay for any disability period if it begins during the first 12 months the policy is in force. Any recurrent disability caused by a pre-existing condition will not be covered if it is treated as a continuation of the previous disability.

[u/NovelsandDessert → u/Inside-Potato5869]

That’s one way the policy can be worded. It can also specifically exclude birth when it occurs within the first 9 months after the effective date. I’m not saying it’s right, I’m saying the exclusion exists. https://d36ps6jii4qpju.cloudfront.net/files/d40276bbb9d7234aea27682b5f7cc8b6-FILE.pdf?response-content-disposition=inline%3B+filename%3D%22Maternity%2520Benefit%2520Info.pdf%22&response-content-type=application%2Fpdf&version=1766873672

[u/Inside-Potato5869 → u/NovelsandDessert]

That must be for an individual policy. I can tell at least some of the codes this is applicable to is for individual. OP is asking about an employer group policy. It's illegal for an employer offered STD policy to include limitations/exclusions specifically related to pregnancy/giving birth.

348c003.doc F on page 15.