Can someone give me insight on this exchange with insurance agent please?

Can someone please help me decipher all this mumbo jumbo? I feel like all I am doing is going around in circles. Does anyone have any experience with Aflac? I know they are independant service agents but do they have supervisors? I feel like I am not getting the answers I need. Unless I am not asking the right questions? I am at my wits end and being pregnant with complications is stressful enough without having to figure out if my claims are going to be denied in 8 weeks. Help please


I am very concerned with regard to my STD policy. I signed up for STD with you through work for one specific reason, pregnancy. You assured me that as long as I was not pregnant when I signed up, I would be covered. You also assured me that bed rest because of complications would be covered. I became pregnant in February and it would appear that due to pregnancy complications my OB is considering putting me on bed rest starting in about mid June/beginning of July. From what I have been reading I am not able to collect any disability from my Aflac policy (prior to delivery) for two reasons: 1) I have not had the policy for 10 months and 2) bed rest is NOT covered. I am concerned that you provided me incorrect information. Please advise me as to what the correct benefits are for this STD policy as relates to my situation as I need to figure out how to pay my rent for six months (which is why I took this policy out to begin with).

Sorry for the delay in getting back to you. Your policy has a 10 month waiting period. This period applys to all policy provisions that are pregnacy related except complications. Un less the bed rest is physian prescribed after the waiting period it will not be covered.

I would like to stress that this is specifically CONTRARY to what you stated in the meeting we had when you signed me up for the policy. I would like to clarify what you mean by ". . .provisions that are pregnancy related EXCEPT complications." I am very disapointed. I would never have taken out a policy that would not cover me for bed rest. Because I was doing IVF, I anticipated that my pregnancy would be high risk. This was the whole reason I took the policy to begin with. And once again, you are the one that stated as long as I was not pregnant when I signed up for the policy there was no problem collecting benefits. I am very confused. Please advise. Additionally, what if the bed rest is physician prescribed before the waiting period AND continues after the waiting period? Are you trying to say that the only thing this policy that you sold me is good for now, is only the 6-8 weeks after I give birth?

I was very clear that there is a 10 month waiting period which means that you cannot be pregnant when you apply for the policy. Ten months MUST expire before delivery. That applies to everything within the ten month period, bed rest if it occurs within the first ten months.If you develop complications before the ten months expire you will be covered.

Message edited 5/6/2009 9:36:42 AM.

Re: Can someone give me insight on this exchange with insurance agent please?

I have had such problems with Aflac recently as well. My agent was unclear and very slow to respond as well. You can try calling the general customer service number to get info. But from what I understand, your bed rest wouldn't be covered unless it was after the 10 month waiting period. Good luck!

Re: Can someone give me insight on this exchange with insurance agent please?

Do you have a copy of the actual policy itself that would help to see how the policy is written/worded. The way he worded it - it sounds as if you won't be covered for anything before 10 months after you sign up. The part that I'm not sure about (not sure if it is a typo on his part) is the sentence where they would cover complications before the 10 months - b.c usually you are put on bed rest by your physician because of complications not just for fun. Which is why it is important to have a copy of the actual policy so you can see how AFLAC is wording it. If you don't have a copy can you ask them for a copy of your policy.

Re: Can someone give me insight on this exchange with insurance agent please?

This is what my policy says with regard to Complications:

COMPLICATIONS OF PREGNANCY: (1) conditions requiring hospital stays (when the pregnancy is not terminated) whose diagnoses are distinct from pregnancy but are adversely affected by pregnancy or are caused by preganncy, such as acute nephritis, nephrosis, cardiac decompensation, missed abortion and similar medical and surgical conditions of comparable severity, and shall not include false labor, occasional spotting, Physician-prescribed rest during the period of pregnancy morning sikness, hyperemesis gravidarum, preeclaimpsia and similar conditions associated with the management of a difficult preganncy not constituiting a nosologically distinct compliaction of Pregnancy.

Re: Can someone give me insight on this exchange with insurance agent please?

Based on what your agent said, it seems as if the policy has a 10 month waiting period for pregnancy and that none of your pregnancy related issues would be covered even if it extends past the 10 month waiting period.

Re: Can someone give me insight on this exchange with insurance agent please?

The written policy will rule over an agents statement. The claim adjuster will know better than the agent about what will and will not be covered. Have you submitted a claim yet?