Are Pre-Existing Conditions Covered When Moving to a New Group Health Insurance Plan?

Changing jobs can be an exciting time in your life. You new job may pay more money or have more opportunities for you to grow as a person. Your new job also brings new benefits as well, and you are concerned about how this will effect your coverage for any pre-existing conditions that you might have. In some instances, your health coverage will continue for any pre-existing condition.

Definition - Pre-Existing Condition

• A pre-existing condition is a health concern that you had before signing up for a health plan. However, the plan only recognizes a condition as pre-existing if you received treatment for it within six months of the date that your policy coverage starts. If you received treatment for a condition prior to that six months, and you have not been treated since, it will not be considered a pre-existing condition.

Limits On Coverage

• If a health plan considers a health condition that you have to be pre-existing, and they are refusing to cover treatment for this condition, there are limits to the amount of time that they can impose these restrictions. The health plan can deny coverage for the condition only for 12 months if you enroll in the plan as soon as you are eligible. If you do not enroll when first eligible, but chose to enroll later, your coverage can be denied for up to 18 months.

Creditable Coverage

• The rules for pre-existing conditions change if you had prior health coverage through another health plan. For every month that you were covered under a prior plan, you will receive a one month reduction in the waiting period for pre-existing conditions to be covered. If you were covered previously for 12 months, the waiting period to be covered for pre-existing conditions would be eliminated, due to this credit. There can not be a lapse in coverage while you are between health plans for more than 63 days for this to apply.

Exceptions to Pre-Existing Conditions

• Some conditions can not be considered under the pre-existing condition exclusions by health plans. Pregnancy can never be excluded, and coverage must be provided immediately. This is true even if the woman had no prior health coverage. Also, conditions that a newborn child or adopted child under age 18 has can not be excluded from coverage as long as the child is enrolled in coverage within 30 days of the date of birth or adoption. If, after this initial enrollment, the family changes health plans, there can not be a break of more than 63 days between coverages. Children in this instance do not need to meet the 12 month creditable coverage rule.