Insurance Laws on Pre-Existing Conditions

Americans suffering from pre-existing conditions often have difficulty finding affordable health coverage with comprehensive benefits. With the passage of The Affordable Care Act, federal law prohibits health insurance companies from denying coverage to children due to a pre-existing condition, and will eventually extend the mandate to cover all Americans, regardless of age or health.

Children

• In 2010, President Obama and Congress enacted The Affordable Care Act, which includes a series of laws designed to reform health care in America and make it possible for all Americans to find health insurance coverage regardless of pre-existing conditions. In September 2010, part of the law when into effect to protect children under age 19 from insurance discrimination due to a pre-existing health condition. For example, if your child has asthma, an insurance company can no longer deny health coverage to him due to the condition.

Adults

• The law will eventually provide the same benefits to adults 19 and older who suffer from pre-existing conditions. Beginning January 1, 2014, The Affordable Care Act will be fully enacted, and insurance companies will not deny anyone coverage due to a pre-existing condition. Additionally, the law prevents insurance companies from charging unreasonable premium prices for policyholders with pre-existing conditions. The law also requires insurers to provide benefits for the condition, instead of providing the policyholder with coverage but omitting benefits for the pre-existing condition.

PCIP

• Until 2014, the federal government and several U.S. states will provide a pre-existing condition insurance pool, or PCIP, to adults with pre-existing conditions. Qualification is not based on income, but rather an applicant's lack of ability to find coverage through private health insurance providers. Those accepted into a PCIP will pay affordable health insurance premiums for comprehensive health benefits. The PCIP is not government insurance, but rather a subsidized program that makes insurance more affordable to enrollees.

Employer Plans

• If you obtain your health insurance through an employer group plan, the federal government limits your health insurance company's ability to exclude your pre-existing condition from coverage. Under the Health Insurance Portability and Accountability Act, or HIPAA, the insurance company must accept your application for coverage, but may deny benefits for a pre-existing condition for up to 12 months, or 18 months if you enroll late. However, if you had previous health coverage for your condition and did not go without coverage for more than 63 days prior to enrolling in your employer's plan, the health insurance company cannot exclude your pre-existing condition from coverage.