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All You Need To Know About Pre-Existing Conditions

Aug 17th, 2012

pre-existing conditionsA pre-existing condition is defined as a health condition that a person has before applying for a health insurance policy or getting a new health plan. It can be used to determine the premium you pay for your health coverage.

Health insurers are in business to make profit. Therefore, they do what they can to minimize losses. People with pre-existing conditions are charged higher premiums and out-of-pocket expenses, given a mandatory waiting period before coverage starts, or even excluded entirely from coverage.

Health Reform and Pre-Existing Conditions
When the United States Supreme Court upheld the legality of the Patient Protection and Affordable Health Care Act, it meant the elimination of pre-existing health condition requirements imposed by health insurers.

Since September 2010, children with pre-existing conditions below age 19 may not be denied health coverage under their parents’ health plan. Furthermore, a child’s pre-existing condition can no longer be excluded from coverage under his or her plan. In 2014, adults will enjoy this provision as well.

The pre-existing condition exclusion
Right now, health insurance companies can reject your application for coverage, charge you extra premium, or exclude coverage for your pre-existing condition.

Your health insurer may provide you with coverage, but costs related to your pre-existing condition will not be covered. This exclusion period can last anywhere from six to eighteen months depending on your health policy and your state’s laws.

Most Americans get their health plans through their jobs. The exclusion period from these plans will depend on your employer and the policies being offered. However, this period should not last more than twelve months. If you enrolled late in the health plan, the period may last until eighteen months. Furthermore, pre-existing conditions are only limited to health problems for which you sought treatment in the last 6 months prior to enrollment.

HIPAA and Creditable Coverage
The Health Insurance Portability and Accountability Act (HIPAA) protects you or your family when you decide to buy, continue, or change your health insurance policy.

This law limits the use of pre-existing condition exclusions. Many health insurance companies are also prohibited from denying you coverage or charging you extra because of your health problem. The law also provides purchase options for health insurance, should you lose your job and coverage. It also guarantees that an insured person can renew his or her coverage regardless of any health problems.

HIPAA does not apply to everyone and to every situation. However, it can help you keep your existing coverage, make switching health plans easier, and help you get health coverage should you lose your health insurance from work and cannot secure any other coverage.

Creditable coverage
Creditable coverage is the period you spent on a prior health plan before you enroll in a new health plan, as long as the gap in coverage does not last for more than 63 days. This period can be used to offset any exclusion period for pre-existing conditions in your new plan.


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