Tips on Finding Health Insurance Even with Pre-existing Medical Conditions



How much coverage you can get on a pre-existing condition varies
from state to state. For people getting insurance through their
job, it is illegal for them to not let you join the plan based on a
pre-existing condition. As long as you are an employee, you have
the same rights as all other employees to the group plan and rates.
The Health Insurance Portability and Accountability Act, also known
as HIPAA, also grants limited eligibility for continuous coverage
for employees who leave their employer, through COBRA laws. If
certain conditions are met, such a person can obtain health
insurance in the individual market on a guaranteed-issue basic like
every one else.

Most insurance companies consider pre-existing conditions as health
conditions that you already have gotten or are receiving treatment
for. Pregnancy, AIDS, high-blood pressure and stroke are all
considered pre-existing conditions. Each insurance carrier has
their own policies and procedures regarding pre-existing
conditions. Some have waiting periods while others totally won’t
cover certain conditions. Having a pre-existing condition obviously
puts you at a higher risk for compensation than people without
pre-existing conditions, but that doesn’t necessarily mean you
can’t get insurance.

HIPAA tells you the conditions under which a person who maintains
continuous insurance coverage is able to purchase individual
insurance on a guaranteed-issue basis. This is free of exclusions
for pre-existing health conditions after leaving an employer group
insurance plan. To qualify for guaranteed issue of non-group, or
individual insurance, a person must have 18 months of prior,
continuous coverage by group insurance. Second, if coverage on
COBRA was available the person must have used all the time he or
she had on that plan. In most states, this period of time is 18
months. Once COBRA coverage is no longer available, association and
individual health plans must cover pre-existing conditions.
Finally, the person must buy an insurance plan with in 63 days of
leaving the group plan to exercise this guaranteed eligibility.

In addition, every state has a mechanism for guaranteed-issue
insurance. If you are not eligible, then there are some other
insurance options. Twenty-eight states operate a “high-risk” pool.
Pool coverage is like group coverage and part of the cost is
subsidized by appropriations from state revenue. Other states offer
guaranteed-issue basic or standard insurance coverage. In order to
find out if your state has one of these opportunities, contact your
department of insurance. An easy way to find an insurance
department is on the Internet. Try the web site of National
Association of Insurance Commissioners (NAIC). In many states,
health maintenance organizations (HMOs) offer guaranteed-issue
insurance. HMOs are much more strict about whom you see but having
coverage of any kind is a need.

In 1996 the laws changed for those people with pre-existing
conditions. Now many people would not be forced to have no
coverage, they can opt for a plan that excludes the disability for
a brief time. The HIPAA (Health Insurance Portability and
Accountability Act of 1996) determined that there are certain
conditions health insurance carriers may and may not cover. HIPAA
defines a pre-existing condition as: “A condition (whether physical
or mental), regardless of the cause of the condition, for which
medical advice, diagnosis, care or treatment was recommended or
received within the 6 month period ending on the enrollment date.”

However, exclusions are generally limited in how long they can be
excluded: Regular on-time entrants may only endure an exclusion
period of 12 months following enrollment. Those who received
treatment for a condition 6 months before enrollment, such as you
were treated for melanoma on January 1, 2005: you can enroll up to
July 1, 2005 and still be eligible but you must wait until July
2006 for benefits to begin. Late entrants must endure a longer
exclusionary period of 18 months, but maintain the same eligibility
requirements for regular on-time entrants above. HMO’s may affix a
“waiting” period of 60-90 days if they have no pre-existing
exclusion policies.

DISCLAIMER: This information is for educational and informational
purposes only. The content is not intended to be a substitute for
professional advice. Always seek the advice of a licensed Insurance
Agent or Broker with any questions you may have regarding any
Insurance Matter.

Find out more Tips on Finding Health Insurance Even with Pre-existing Medical Conditions

One Response to Tips on Finding Health Insurance Even with Pre-existing Medical Conditions

  1. Hi, I saw that you were discussing COBRA insurance. I have a website dedicated to COBRA questions and answers and I thought it might help you. Or, if you want you can call me and I can maybe answer your questions. 608-755-7959

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