What Heath Insurance Covers Preexisting Conditions?

A pre-existing condition is a disability or illness that existed before an individual enrolled in a health insurance plan. For employer-sponsored insurance purposes, a pre-existing condition is any condition where medical advice, diagnosis or treatment was received within six months of enrolling in a health plan. Most insurance companies have provisions that exclude pre-existing conditions from coverage. Although restrictions may apply, some health insurance plans cover people with pre-existing conditions.

Pre-existing Health Insurance Plan

• The United States federal government passed legislation in March 2010 that created a health insurance program for individuals denied health coverage because of a pre-existing condition. The Pre-existing Condition Insurance Plan covers health benefits such as primary care, hospital services and prescription medications. All benefits are available to treat a pre-existing condition. A major benefit of the federal PCIP is that recipients are not charged a higher premium because of the pre-existing condition. All rates are based on factors such as age and gender. Before an Individual can enroll in the PCIP, certain eligibility requirements must be met. The health insurance plan only covers legal U.S. residents. Also, recipients must have been uninsured for at least six months. Furthermore, the recipient must suffer from a pre-existing condition or have been turned down for insurance because of current health status.

Indemnity Insurance Plans

• Indemnity insurance plans are guaranteed issue health plans that cover pre-existing conditions. Most medical indemnity insurance plans do not require health questionnaires, physicals or proof of health status. These plans cover limited medical benefits that vary by individual insurer. Most guaranteed issue insurance plans cover wellness visits, hospital services up to certain limits, emergency room services and laboratory benefits. It is important to note that some guaranteed issue insurance plans do not cover pre-existing conditions right away. Although some benefits have no waiting period, plans typically provide full benefits for the pre-existing condition after six or 12 months.

State-Sponsored Health Insurance

• State-sponsored health insurance plans are provided by state Health and Human Services Departments or similar government agencies. State insurance plans consist of health insurance pools for individuals who cannot obtain private insurance because of their health. States are not required to provide health insurance to residents with pre-existing conditions, so not all states offer a health insurance pool. Residents of states without a health insurance plan may be eligible for the federal Pre-existing Condition Insurance Plan. Similar to the PCIP, to qualify for state-sponsored insurance pools, residents must have a condition that prevents them from getting private insurance elsewhere.

Considerations

• By the year 2014, no private insurance carrier can turn down an individual solely for having a pre-existing condition. According to the Affordable Care Act, all insurer discrimination against pre-existing conditions is prohibited. Individuals who suffer from a health condition or disability will have the freedom to shop around for quality insurance coverage without the fear of denial or high insurance premiums because of their health.