Health Insurance Eligibility Requirements

Health insurance is a vital part of many family's financial plan. Health insurance provides protection against a financial catastrophe by providing financial benefits to individuals covered under the policy if those individuals become sick or need medical attention. However, health insurance does have certain eligibility requirements to meet in order to qualify for coverage.

Pre-Existing Conditions

• Most states have extensive laws concerning pre-existing medical conditions. However, the rules for pre-existing conditions may vary from state to state. In general, however, health insurance will not cover any condition that you have prior to being accepted for coverage by the health insurance company. This pre-existing condition exclusion is often modified, however, to exclude only pre-existing conditions for the past six months. In some states, this exclusion is waived if you are switching health insurance plans and did not have a lapse in coverage from the old plan to the new plan. However, in some states, medical underwriting is completely illegal and you cannot be denied coverage.

Waiting Period

• For group health insurance, you must wait the required waiting period as prescribed by your employer's health insurance administrator. These are typically 90 days after your first day of employment but may be shorter. During the waiting period, you may not apply for health insurance and are not covered for any medical expenses. Medical expenses are also not retroactive to your first day of employment. If you miss the enrollment period after you are hired, you must wait for open enrollment in the plan, which is often (but not always) January 1 of the calendar year.

Duplicate Coverage

• For some group health insurance plans, you are not allowed to have duplicate coverage. This means that if you already have health insurance, you cannot enroll in another health insurance plan offered by the company.

Available Plans

• To be eligible for a health insurance plan, the plan must be offered in your area or state. For example, New York state uses community rating. This means that all plans are tightly controlled and priced according to specified areas in the state. It also means that health insurance is specific to each designated area, called a "community," in the state. For example, you cannot choose a health insurance plan that is not offered in the community in which you live. The only exception to this rule is if you are purchasing health insurance through your employer and the employer is based in a community other than where you live.