Pre-existing Conditions & Creditable Insurance Coverage

To protect themselves against exorbitant claims from consumers who buy health insurance only to pay for expensive procedures, insurance companies place restrictions on benefit payments for pre-existing conditions. Depending on your situation, your insurance plan may not immediately cover treatment costs associated with pre-existing conditions.

Pre-Existing Conditions

• The specific definition of a "pre-existing condition" is key in determining whether the cost of services for a particular health condition is covered by your health insurance policy. Every insurance carrier has its own unique definition of a pre-existing condition, resulting in potential confusion and coverage disparities. Simply put, a pre-existing condition is anything you've been treated or counseled for within the past year, or anything for which an average person would have sought treatment.

Benefit Limitations

• Since insurance is regulated at the state level, each state sets its own rules for coverage limitations. If your ailment is deemed to have been pre-existing, most states allow carriers to deny payment of claims for treatment for the first six to 12 months after your policy becomes active. Any services you receive related to that condition must be paid out of your own pocket until the limitation period expires.

Limitation Period

• The possible denial of coverage for pre-existing conditions only occurs if you've been without medical coverage for an extended period of time. In most states, the length of time you remained uninsured before buying a new policy must be greater than 60 days before a health insurance carrier may consider denying benefits for pre-existing conditions. In some states, however, this duration is only 30 days.

Credible Insurance Coverage

• When your medical coverage ends, the insurance carrier mails you a Certificate of Credible Coverage detailing the dates your coverage began and ended. This official document and your application paperwork must be presented to your new health insurance carrier . This can eliminate possible confusion about pre-existing condition limitations.