Can Insurances Deny Coverage for Pre-Existing Health Conditions in Arizona?

A pre-existing condition is an illness or medical condition that an individual has suffered from prior to applying for or obtaining health insurance coverage. With most health insurers, pre-existing conditions are not insurable. The insurance company can deny coverage, exclude the condition from coverage or charge an extremely high premium. In Arizona, insurance companies can deny coverage for pre-existing conditions. Arizona does not have a state-sponsored health insurance plan that covers pre-existing conditions, but individuals do have other options.

Affordable Care Act

• Although Arizona health insurers may deny coverage for individuals with a pre-existing condition, the Affordable Care Act was passed to hold insurance companies more accountable, lower health care costs and guarantee more health care coverage for all Americans. By the year 2014, all health insurers will be prohibited from denying coverage to plan participants who have a pre-existing condition.

Exceptions

• There is one exception to the denial of pre-existing conditions in Arizona. No health insurer may deny coverage for a child less than 19 years old regardless of health condition as long as the child meets other plan requirements. According to the Affordable Care Act, insurance for children cannot be limited or denied simply because the child has an existing health condition. This rule applies regardless of whether the child's condition was discovered or treated before applying for coverage. The exception applies to all insurance plans, including employer-sponsored plans as well as individual insurance plans.

Pre-Existing Condition Insurance Plan

• Arizona residents who have been denied health insurance because of a pre-existing condition can apply for coverage through the U.S. Department of Health and Human Services Pre-Existing Condition Insurance Plan (PCIP). To qualify, Arizona residents must be U.S. citizens or legally present in the U.S., must have been uninsured for the last six months, and must have a pre-existing condition or been denied coverage because of the health condition.

  Benefits available in the PCIP plan include primary and specialty care, hospital care, prescription drugs and more. With the PCIP, a deductible of between $1,000 to $3,000 may apply depending on plan options. Also, insurance premiums are based on the age of the applicant.

Considerations

• Some Arizona insurance companies will not deny coverage for a participant with a pre-existing condition, so it is necessary to shop around for coverage. If you need insurance to cover treatment of the condition, you may have to take advantage of the federal health insurance plan or obtain a plan that offers limited coverage. Many insurers offer health coverage without medical exams or statements of health for lower costs than comprehensive medical plans. The Arizona Department of Insurance is an effective resource for identifying coverage options for pre-existing conditions.