How Does a Pre-Existing Condition Affect Getting New Insurance Coverage With Blue Cross/Blue Shield?

Pre-existing health conditions may preclude an individual from obtaining health insurance coverage through Blue Cross and Blue Shield (BCBS). Though BCBS may offer you coverage, the cost of the policy may be higher because of your pre-existing condition. The Affordable Care Act allows for coverage of pre-existing conditions if you cannot obtain or afford insurance as a result of the pre-existing conditions. Regional BCBS carriers manage many of the states' pre-existing care plans.

Group Health Insurance

• If you work for a company that offers group health insurance, including your regional Blue Cross Blue Shield plan, or you can get insurance through a union trust or association, you should enroll if you have a pre-existing condition. Group health insurance offered through employers, trusts and associations will not deny you coverage because of pre-existing conditions. In rare circumstances, if the group size is under 50, your state may allow for individual underwriting review of each applicant and deny the group as a whole. However, this is unlikely, and group insurance is underwritten as a whole group, not individually.

Individual BCBS Plans

• If you do not have the opportunity to enroll in a group health plan, you can apply for an individual health insurance policy through your regional Blue Cross Blue Shield. Visit your regional BCBS website to obtain information about individual plan options, and compare features such as premiums, deductibles and co-insurance amounts. Note whether any pre-existing conditions are excluded and whether riders are available for specific conditions. You can apply directly on the website or by phone; however, your application may be denied coverage as a result of your pre-existing conditions.

The Affordable Care Act

• The Affordable Care Act, enacted in September 2010, is a federal act with a provision regarding the Pre-Existing Condition Insurance Plan. The PCIP ensures that anyone who cannot obtain health insurance as a result of pre-existing conditions will get covered. In many states, the regional Blue Cross Blue Shield Plan administers the PCIP. For example, Maryland's pre-existing plan, the Maryland Health Insurance Plan, is administered by CareFirst BlueCross BlueShield and CareFirst Blue Choice. If your state does not offer a PCIP, you will receive coverage through a federal program.

BCBS Association

• Blue Cross Blue Shield is an association and not one national health insurance plan. Each Blue Cross Blue Shield is its own independent insurance company. For example, Blue Cross Blue Shield of Illinois is not the same company as Anthem Blue Cross of California. There are 39 regional Blue Cross Blue Shield companies, and several larger states have multiple regional Blues companies. To find your regional BCBS company and learn about plan options, applying for coverage or calling to inquire about coverage for pre-existing conditions, visit the BCBS association website or call 888-630-2583.