Health Coverage for Preexisting Conditions

Getting health coverage for chronic medical conditions is a challenge for those who've been unemployed and uninsured for several months. Upon finding a new employer and becoming eligible for enrollment in its group health plan, the worker may still have to wait a year before benefits start for the preexisting medical condition. This will end when provisions of the Patient Protection and Affordable Care Act (PPACA) take effect.

Ends Preexisting Exclusion

• U.S. President Barack Obama, on March 23, 2010, signed legislation that prohibits group health plans and insurers from denying or delaying coverage to new enrollees for preexisting medical conditions. According to a report compiled by U.S. Senate Democrats, common chronic medical conditions on which health plans and insurers have imposed preexisting condition exclusions include obesity, hypertension, diabetes, cardiovascular disease and mental illness.

Benefits Start in 2010

• The ban on preexisting condition exclusions takes effect in 2014, but some individuals won't have to wait for health coverage. PPACA establishes a temporary insurance program for people with chronic diseases who've been uninsured for six months or longer set to begin July 1, 2010, according to U.S. Department of Health & Human Services guidance on PPACA. Additionally, after Sept. 23, 2010, the law prohibits health plans and insurers from imposing preexisting condition exclusions on children under 19 and extends dependent coverage to age 26.

PPACA Provisions

• The health care reform law will prohibit lifetime limits on benefits and by 2014 end annual limits on coverage. PPACA also prohibits health insurer-initiated rescissions or policy cancellations after an enrollee becomes ill. The law limits the ability of health insurance companies to charge higher premiums due to heath status, gender, family medical history or occupation.

Early Compliance

• PPACA builds upon health insurance reforms enacted in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) which limits the length of time health plans and insurers can delay benefits for ongoing medical conditions. Although some health insurers have indicated they will adopt some PPACA provisions earlier than the effective date, health plans and insurers remain regulated by HIPAA preexisting condition guidelines until 2014.

HIPAA Portability Provisions

• Under HIPAA, a health insurer may impose a 12-month waiting period for benefits on an individual who received a diagnosis or treatment for an illness within six months of enrolling in a group health plan. If the patient had insurance prior to enrollment, the plan must credit the length of that coverage towards the one-year waiting period. An individual who didn't have health insurance within 63 days of enrolling in a new plan may have to wait a full year to receive benefits for care on an illness that the insurer classifies a preexisting medical condition.