Are Pre Existing Conditions Waived on All Insurance Policies?

A pre-existing condition is a medical condition that exists prior to enrolling in a health insurance plan. Private health insurers often waive coverage for pre-existing conditions, while others deny coverage to individuals with pre-existing conditions altogether. However, a combination of federal laws and government health insurance programs make it possible for many individuals to find coverage for an existing medical condition.

Employer Insurance

• Group insurance acquired through an employer's health plan is subject to the Health Insurance Portability and Accountability Act, or HIPAA. The laws included in HIPAA forbid insurers from denying health insurance coverage to any employee due to one or more pre-existing conditions. So long as an enrolling employee had coverage for his pre-existing condition within the 63 days prior to enrollment, insurers cannot exclude payment of benefits for treatment of the medical condition. However, if the employee had no coverage for his pre-existing condition for more than 63 days prior to enrollment, insurers may exclude benefits for the condition for 12 to 18 months.

Government Health Insurance Programs

• Government health programs, such as Medicaid and the Children's Health Insurance Program, do not waive coverage for pre-existing conditions to any qualifying individual or family. Benefits are the same for all enrollees, but because each individual U.S. state regulates its own version of the programs, coverage and benefits vary geographically by state of residence. All states that participate in the Medicaid and Children's Health Insurance Program must provide the minimum federal coverage requirements, but some may elect to expand benefits to cover additional health care services and treatments.

The Affordable Care Act

• As of September 2010, The Affordable Care Act does not permit a waiver of coverage for pre-existing conditions of insured children. The law only applies to children under age 19 enrolled in a health insurance plan that became effective after the passage of The Affordable Care Act. However, beginning in January 2014, all health insurance policies -- regardless of when they became effective -- must provide coverage for pre-existing conditions for all Americans, regardless of age or health history.

Consideration

• Americans who cannot gain health insurance coverage for a pre-existing condition through an employer's group plan, a government health plan or a private insurer may apply for health insurance through a federal or state pre-existing condition insurance pool, or PCIP. Eligibility for state PCIP enrollment varies, but the federal pre-existing condition insurance pool accepts individuals who are uninsured for at least six months prior to applying for coverage through the federal PCIP, and who have been denied insurance due to a pre-existing condition. The insurance plans available through PCIPs are not free, but do not discriminate based on medical history. Instead, insurance premiums through PCIPs depend on age and the level of coverage selected.