Rules About Pre-Existing Health Conditions When Looking to Change Insurance

Choosing a health insurance provider for you and your family is an important decision. Not only should your insurance carrier provide you with access to your preferred health providers, but your benefits should also cover all of your health needs at an affordable price. If you have pre-existing health conditions, your provider may or may not have to cover these conditions by law. However, if you cannot find pre-existing condition coverage, you may have other options.

Employer Plans

• If you're thinking of changing your health insurance to your employer's health plan, or your spouse's, the Health Insurance Portability and Accountability Act, or HIPAA, protects your rights concerning pre-existing conditions. Under the law, group insurers cannot deny you coverage if you didn't seek medical consultation, treatment or diagnosis in the six months preceding your application for insurance. Otherwise, the insurance company can exclude your pre-existing condition from your coverage benefits for a period not to exceed 12 months, or 18 months if you enrolled in your employer's health insurance program late.

Individual Policies

• If you find yourself shopping for your own health insurance due to a lack of coverage at work, self-employment, or specific coverage needs, your new health insurance policy may not cover your pre-existing condition. When you apply, your new insurer will inquire about your health history, at which time you must disclose information about your pre-existing condition. Failure to do so is insurance fraud. Unfortunately, the health insurance company can use this information to charge you higher premiums, exclude your pre-existing condition from coverage, or even deny you health insurance coverage altogether.

Considerations

• You may have other health insurance options to explore before you shop for an individual policy on the private market. For example, if you lost your insurance coverage because you were laid off from your job, you may be eligible for COBRA, which allows you to pay your own premiums for your previous insurance for up to 18 months. If you lost your previous coverage due to a spouse's death, or because you lost your status as a child dependent on a parent's coverage, you can pay for an extension of your benefits for up to 36 months.

The Affordable Care Act

• The Affordable Care Act includes a series of laws designed to eliminate health insurance discrimination against those with pre-existing conditions by January 2014. At that time, no health insurance company can deny or exclude coverage for a pre-existing condition, nor can insurance companies charge individual policyholders more money to cover such conditions. Though adults will not benefit from this law until 2014, the law became effective for children under age 19 in September 2010. Adults who cannot find affordable health insurance for a pre-existing condition prior to 2014 can apply for health insurance through the federal government's pre-existing condition insurance pool, or PCIP, which provides qualifying applicants with more affordable coverage for all conditions.