Moving to USA on L1-B With Pregnant Wife
 

Hi,

My Company is sending me to USA for two years and i have a couple of questions i need help with:

1. My L1-B has been approved and I am awaiting paperwork from the US so i can book my interview at the US embassy in London. When will my wife be able to apply for her spouse visa and what is the procedure?

2. When she does fly out with me is there any medical insurance that will cover pregnancy? She is currently 5 weeks pregnant and she'll be coming back to London at around 26 weeks pregnant and then hopefully give birth in London. So i wanted to know if there was cover for the 12th & 20th week ultrasound scans?

Many thanks in advance.

Re: Moving to USA on L1-B With Pregnant Wife
 

There will not be cover for her at all unless your employer is offering you health insurance or you purchase (usually expensive) cover individually. Bear in mind that even in routine pregnancies there are also blood tests etc that are run during those time periods, and if she develops any kind of complication or (heaven forbid) early delivery, you MUST have cover or will be easily bankrupted.

Re: Moving to USA on L1-B With Pregnant Wife
 

Be absolutely certain to negotiate health care insurance with your company before you sign a contract. Be certain they pay 100% of the premiums. Be certain that the health insurance they offer you covers pregnancy as a pre-existing condition. If they refuse to do any of those 3 or the pregnancy is not covered... I suggest you pass on the job.

Ian

Re: Moving to USA on L1-B With Pregnant Wife
 

Hello and welcome

My paperwork was done the same time as my OHs also by the company lawyers. I went to the embassy at the same appointment and was asked no questions at all. I'm the L2 to his L1a.

I'm on the company health insurance. We still pay 20% and that works out at around $20 for every blood test and $60 for every scan. Maternity care isn't the same here as the UK. She won't get 12 and 20 week ultrasounds. You get an ultrasound as soon as you register with an OBGYN (and you sign upfront and pay upfront for your whole treatment through to birth). You also get a pap, HIV test, and a few other tests along with full blood work. Then you go every month for appointments. You get tested for more stuff that you would in the UK (like strep B). It varies state to state as well, so this is just my Texas experience. In general, it's a lot more medical and all done by an obgyn rather than midwives.

If your OH wants more info, she can always pm me when you have done enough posts. Let's just say they are a lot more erm, using of latex gloves in this country than the UK:o

Re: Moving to USA on L1-B With Pregnant Wife
 

Why come back to London to pop the kid out - if your US company health insurance covers it I'd bang it out in the US and then the kid is automatically dual citizen (afaik) - potentially a pretty useful status for the kid when they grow up (but with some downsides).

Re: Moving to USA on L1-B With Pregnant Wife
 

As per the other responder, my husband's paperwork was done the same time as mine. I was the L-1, he was the L-2.

Was your employer not aware that you had a wife who would be going with you?

Have you already enquired about what health insurance your employer is offering and if it covers pregnancy?

Re: Moving to USA on L1-B With Pregnant Wife
 

Hi,

You should start with our health care wiki:

http://britishexpats.com/wiki/Health_Insurance

A key issue is whether this is a "pre-existing condition". In the USA you don't say, break your arm and then get on the phone and call insurance companies and buy a policy, then show up at the hospital and say "treat me it's on the insurance company". The broken arm was a "pre-existing condition" prior to your buying insurance.

Now for pregnancy it's a bit tricky. If you are joining your company's health insurance, i.e. a 'group policy' that was negotiated by the company and is offered to their employees and family, then pregnancy is NOT considered a pre-existing condition. The insurance policy should cover it. You will need to see how much of it they cover. There is a monthly charge (the 'premium') but how much of it you pay and how much the company pays is part of your work agreement. Some people have their employer pay 100%, many more people have to pay 100% themselves. Then there is the issue of 'deductibles' (the amount you pay first before insurance starts paying) and the issue of 'copays' (the amount you pay for each treatment). Then there is what they call 'co-insurance' whereby you pay 10% or 20% of the treatment cost and the company pays the other 80-90%. All depends on the policy.

On a more positive note there is also the issue that many insurance companies treat maternity care different, or outside of the normal deductibles and copays. Sometimes the insurance companies realize that it simply makes financial sense for them to encourage 'better' maternity care to have a health pregnancy and baby rather than to skimp on maternity care and end up with a much more expensive baby down the road. For example we had a total of 1 copay, our first visit to the OB/GYN. The next 12 visits or whatever there was no copay. With the very good insurance we had the cost of our first child was about $400 US, but $350 of that was because we upgrade our recovery room at the hospital and $5 was because we used the TV in the delivery room because we were bored waiting for the kid to arrive.

You will, however, have to ensure that the insurance company recognizes your NHS coverage as 'credible pre-existing coverage' such that your policy in the USA kicks in from day 1 of your arrival, and there is not a 30-60-90-180 day delay as is the case with some policies.

If you attempt to buy 'individual policy' outside of the company's offerings, then the insurance companies CAN claim pregnancy is a pre-existing condition. They don't have to pay ANYTHING for any medical work, procedure, doctor visit, scan, test etc. related to the pregnancy.

So, is your head spinning after all of this? I hope so.

What you really need to do is have a long sit down / phone call with the HR people IN THE USA who know this stuff inside and out. Don't rely on the local UK folks who probably aren't as experienced with the ins and outs of US health care rules and regulations. Get on the phone, or send over and email with detailed questions about:

* is my spouse covered
* is their a waiting period for coverage to start?
* do I need a note from the NHS to show prior credible coverage?
* what is the premium each month?
* what is the co-pay for maternity visits?
* what is the hospital co-pay?
* what is the test co-pay?
* what is the level of co-insurance?
* what is the deductible on this plan?

etc., etc.

Sorting out the insurance is more important than your salary. If you screw up here, the bills could easily wipe out years of your salary. We had a member who didn't have insurance and slipped from a ladder and ended up with $450k in medical bills in about THREE DAYS of intensive care. That's not a typo. Our simple, non-complicated birth of our second child cost $16,000 if we didn't have insurance (it was less than $1,000 since we did have insurance).

Good luck with the new job and negotiations, and congratulations on the new baby.

Re: Moving to USA on L1-B With Pregnant Wife
 

Will the airline even let her fly at that stage? Will the NHS even consider her resident or that birth an emergency that they wouldn't possibly look for reimbursement? That all depends on the local health authority.

Knock the kid out in the US, it'll have duel citizenship and family can come visit, much easier.

Re: Moving to USA on L1-B With Pregnant Wife
 

Also, I think that if the child is born in the US then you will need to claim British citizenship for it at the UK embassy. You will also need to obtain a UK passport in addition to a US passport - otherwise the child will be treated as a US citizen on entry to the UK.

Child will enter and leave the US on its US passport and will present the UK passport on entry to the UK.

Re: Moving to USA on L1-B With Pregnant Wife
 

sorry for asking maybe an odd question but people here go on about the bills etc for healthcare


what about all these illegals and hispanics etc etc that are all pumping out kids rapidly to make anchor children (US citizens etc) I doubt any of those people pay their bills when they go to the top hospitals and I doubt they give birth on the street either

so what gives are you guys paying for their births too? I can see some people why when they bring their old relatives they would rather plead poverty and take a chance rather than fight with insurance people.

Again my gut feeling hospitals must write off millions in bills.

Re: Moving to USA on L1-B With Pregnant Wife
 

Not claim it but document it either with a birth registration or UK passport. The child is British at birth (assuming parent is British otherwise than by descent) and would still be even without the passport or birth registration.

Re: Moving to USA on L1-B With Pregnant Wife
 

You're talking about emergency care - someone arriving at the hospital in active labour and uninsured. We're talking (mostly) about prenatal care, which is not classed as emergency. Yes, the OP's wife could come over uninsured, have no prenatal care, and gamble that nothing goes wrong requiring immediate treatment. She could gamble that, in the event that something does go wrong and she receives emergency treatment, they are somehow able to duck the bills without getting bankrupted by them.

But that's not my idea of a low-stress pregnancy.

Re: Moving to USA on L1-B With Pregnant Wife
 

Most will, most of those would probably ask for a doctor's note dated within the last 24-72 hours though.

The wife got asked if she had a note just recently on two different airlines. We were carrying a 5 month old baby so she must have gotten shacked up pretty darn quick! Nope, just too many cakes. :rofl:

Re: Moving to USA on L1-B With Pregnant Wife
 

Oooh, I would have been furious!
It's before the 3rd trimester so should be fine, although I'd probably get a doctors note just in case.

Re: Moving to USA on L1-B With Pregnant Wife
 

Won't need to get a UK passport unless they intended to move back to the UK. US passport will be fine for holidays, which is much cheaper than a consular issued UK passport.

They can always get the UK passport in the UK while on holiday. Registering the birth with the embassy in the US is worth doing, IMO, but I would wait to get the certificate in the UK the following September was it would be 10GBP v $140 ish.

Re: Moving to USA on L1-B With Pregnant Wife
 

Anchor babies are a myth. The kids can't sponsor their parents until they are 21.

Emergency care can be free for the poor, that's just to get them stable and then punted else where. That won't get you regular health checkups on the baby.

Re: Moving to USA on L1-B With Pregnant Wife
 

The impression I get is that plenty duck bills as its quite obvious if you bill someone thousands of dollars ++ with no cents to their name they aint going to see a dime of it and from what I was aware federal law states that no treatment should be denied to someone due to lack of ability to pay.

You dont see infant mortality like in Africa etc in the US so there must be some facilities for the poor. Either that or they know someway of getting treatment that people on here dont.

Re: Moving to USA on L1-B With Pregnant Wife
 

Despite the 5-year-ban on new immigrants receiving Medicaid and Medicare funding, in some states their are public resources available for low-income pregnant women, regardless of immigration status. One of the most common exceptions that states opt to use is for state funds for Medicaid for pregnant women, as an unhealthy baby will cost them far more in medical bills than treating the mother with pre-natal advice and checkups. California, New York, and a few other states with large immigrant populations have some programs for this.

Still pregnant women do show up at the hospital emergency room. In fact there are occasional reports in the border areas of women in labor running through the checkpoint to the US side so that their kid will be born as a USCitizen.

By law and practice, hospitals cannot turn away people seeking emergency care. They still bill them for the services, but most of these bills are never paid, or negotiated out to a very small amount. The hospitals then charge others a bit more to cover these costs, and in many cases, end up going bankrupt themselves (many hospitals in low-income areas are in significant financial distress).

Relying on emergency care is, well, nuts if you are looking to settle in the US long-term. The costs of delivering medical care in an emergency room is almost always more expensive than 'normal' admittance in a hospital, and failure to pay will be a knock on your credit rating that will last for many years. (Of course some of those who are here without legal status or already in financial trouble don't necessarily care that much about their credit rating).

Re: Moving to USA on L1-B With Pregnant Wife
 

Infant mortality rates here are pretty shit compared to most of the western world though, but that's a hard stat to really take to much from as there's such diversity to this country.

Anyway, the problem is, you can't dodge medical bills or student loans by going bankrupt, so even if you end up paying pennies a month, you pay till you die.

And not being treated is different from not being billed and what is or is not an emergency also makes a big difference.

It, along with everything medical related in the US is complicated.

Re: Moving to USA on L1-B With Pregnant Wife
 

With the exception of emergency medicaid. If you end up in the hospital within the first 5 years or are an illegal immigrant, you can apply for emergency medicaid to cover the bills if you qualify based on income and your sponsor will not have to reimburse the government.

Re: Moving to USA on L1-B With Pregnant Wife
 

Yes, there is that exception. It doesn't cover prenatal or post-natal care but can be used for labor and delivery in some circumstances, according to this document:

http://www.guttmacher.org/pubs/tgr/06/2/gr060206.html'

Re: Moving to USA on L1-B With Pregnant Wife
 

Thank you for all your replies.

My wife's visa has been sorted out and now we both have an interview at the embassy next week.

I'm still waiting to hear from the company health insurers to see what cover they can offer so fingers crossed.

Re: Moving to USA on L1-B With Pregnant Wife
 

Company insurers have said they will not be able to insure my wife as she is already pregnant and the policy has a 10 month waiting period... Hmmmmm decisions, decisions, decisions!

Re: Moving to USA on L1-B With Pregnant Wife
 

Ridiculous. They are trying to basically treat you as having no prior coverage. You should call back and tell them that under the Health Insurance Portability and Accountabilty Act (HIPA), NHS coverage qualifies as pre-existing coverage and there should be no waiting list, no pre-existing conditions. See what they say.

Wikipedia:
Title I of HIPAA regulates the availability and breadth of group health plans and certain individual health insurance policies. It amended the Employee Retirement Income Security Act, the Public Health Service Act, and the Internal Revenue Code.
Title I also limits restrictions that a group health plan can place on benefits for preexisting conditions. Group health plans may refuse to provide benefits relating to preexisting conditions for a period of 12 months after enrollment in the plan or 18 months in the case of late enrollment.[2] However, individuals may reduce this exclusion period if they had group health plan coverage or health insurance prior to enrolling in the plan. Title I allows individuals to reduce the exclusion period by the amount of time that they had "creditable coverage" prior to enrolling in the plan and after any "significant breaks" in coverage.[3] "Creditable coverage" is defined quite broadly and includes nearly all group and individual health plans, Medicare, and Medicaid.[4] A "significant break" in coverage is defined as any 63 day period without any creditable coverage.[5]

Re: Moving to USA on L1-B With Pregnant Wife
 

Penguinsix has it right... you are protected under HIPAA, and the NHS does count as prior coverage. Whoever you spoke to, isn't familiar with federal law. I suggest speaking to someone higher up the food chain.

Ian

Re: Moving to USA on L1-B With Pregnant Wife
 

Please bear in mind that you will NOT get insurance cover for the pregnancy with individual health policies, should you have to consider this as an option.

Re: Moving to USA on L1-B With Pregnant Wife
 

Subscribed to this thread. Will come back with the link. I relocated at 14 weeks pregnant.

Will find the relevant posts that have the letter your UK GP will kindly provide confirming current cover. (Your GP is within their right to charge for this letter.)


Someone write a reply so that it pops up that there's anew reply pls, then I'll remember to include links...

Thanks!!

Re: Moving to USA on L1-B With Pregnant Wife
 

Hello Ozzidoc! Here's your pop up reply :)

Re: Moving to USA on L1-B With Pregnant Wife
 

As a general aside, the complexities of many things in American life, when applied to individuals from other countries, often confounds many employers. Things that are relatively ordinary when applied to a US Citizens, such as opening a bank account, getting a drivers license, and dealing with health insurance, often get overly complicated when an employer has to deal with someone who, say doesn't' have a Social Security Number, or a US credit rating, or a history of US health insurance.

HIPA is one of those things that can be difficult when coming from another country to the USA. For that reason, I would really encourage you to re-examine this with your employer, and push for a 'solid' answer specific to YOUR SITUATION and not just off a form that is mainly used for other US citizens. If they are not familiar, could you ask them to double check and possibly call the insurance agency, asking about NHS applicability and HIPA.

I think you really just got a standard "canned" answer that might not be applicable. If for some reason there is a ban on coverage, then you should really consider the potential problems of being uninsured and pregnant in the US. It might be worth it to stay in the UK for the time being until the baby arrives.

Re: Moving to USA on L1-B With Pregnant Wife
 

Hey Ozzio...how are you doin'?

Re: Moving to USA on L1-B With Pregnant Wife
 

The NHS is a recognized insurance provider for the purposes of Creditable Cover.

All I had was a letter from my doctor on the practice letterhead. It was stationery from the doctor's practice (practice name, address, doctors, etc.)

You could additionally provide a copy of your national insurance card. The law says that you must cooperate with their efforts to verify coverage.


Here's a sample letter that's similar to mine, but different in that I was born in another country.

"This is to certify that Ozzidoc (Date of Birth xxxxxxx) has been automatically covered by the NHS (National Health Service) from the date of her birth. The National Health Service is a public health plan established and maintained by the government of the United Kingdom. It provides comprehensive health care to all citizens of the United Kingdom. Ozzidoc, as a natural born citizen of the UK, has been continuously fully covered by this plan since birth."

Actually - continuously doesn't even matter - just the past 18 months.




***** With ongoing thanks to Tracy who has provided lots of guidance around this subject in the past!

Re: Moving to USA on L1-B With Pregnant Wife
 

Hi all!

I'm fine. Crazy busy. We are having a belated 2nd birthday party for Millie this weekend. I'm in town every 4th - 6th week at the moment, so every minute is precious! I rotate into a different, calmer dept in a few weeks time, so you'll see more of me on here!

Hope all is well in the land of BE :)

Re: Moving to USA on L1-B With Pregnant Wife
 

Did you have any medical cover at all to accompany the letter your Dr gave? So if NHS cover you did you pay any costs at all? Whom were they billed to?

Re: Moving to USA on L1-B With Pregnant Wife
 

You've got the wrong end of the straw.

Ozzidoc is saying that she produced the letter to her insurance company to prove she had received continuous coverage in the UK up to the point of her move. Therefore, the insurance company couldn't refuse to insure her for not having coverage up to that point in her pregnancy.

Re: Moving to USA on L1-B With Pregnant Wife
 

Maybe its because the private medical insurance is with UK company? It's axa/ppp international and i thought it would be fine to insure with them but in their terms and conditions they have 10 months waiting period and the representative i spoke to confirmed that.

So if i was to produce that letter to them along with mentioning HIPA do you think they will change their stance?

Re: Moving to USA on L1-B With Pregnant Wife
 

You're using a UK medical insurance company for coverage in the US? Why?

Re: Moving to USA on L1-B With Pregnant Wife
 

According to their website exclusions include:

If you have Standard cover or your company has not chosen this benefit option, routine pregnancy and childbirth.


http://www.axappphealthcare.co.uk/in...ons-exclusions

So you probably need to speak to your company and tell them to arrange cover, or it's a no go. IMO you would have to be mental to move while pregnant with no insurance.

Re: Moving to USA on L1-B With Pregnant Wife
 

Im not using them yet but i enquired as they provided private medical insurance to the company that i work for. So if its best to use a US company then which company or policy will allow a letter from the NHS and use it in conjunction with HIPAA?

Re: Moving to USA on L1-B With Pregnant Wife
 

The US company will probably already have group insurance coverage with a US healthcare insurance company. If so they will accept the letter from your GP stating that you and your wife have been continually covered by the NHS for all medical treatment.

Re: Moving to USA on L1-B With Pregnant Wife
 

Who provides your companies group medical insurance? You need to speak to them.

Private health insurance fees are astronomical.