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SolveYourProblem
Article Series:
Health Insurance
How
To Get Health Insurance:
Pre-existing Medical Conditions
How
much coverage you can get on a pre-existing condition varies
from state to state. For people getting insurance
through their job, it is illegal for them to not let you join
the plan based on a pre-existing condition. As long as you
are an employee, you have the same rights as all other employees
to the group plan and rates. The Health Insurance Portability
and Accountability Act, also known as HIPAA, also grants limited
eligibility for continuous coverage for employees who leave
their employer, through COBRA laws. If certain conditions are
met, such a person can obtain health insurance in the individual
market on a guaranteed-issue basic like every one else.
Most insurance companies consider pre-existing conditions
as health conditions that you already have gotten or are receiving
treatment for. Pregnancy, AIDS, high-blood pressure and stroke
are all considered pre-existing conditions. Each insurance
carrier has their own policies and procedures regarding pre-existing
conditions. Some have waiting periods while others totally
won’t cover certain conditions. Having a pre-existing condition
obviously puts you at a higher risk for compensation than people
without pre-existing conditions, but that doesn't necessarily
mean you can't get insurance.
HIPAA
tells you the conditions under which a person who maintains
continuous insurance coverage is able to purchase individual
insurance on a guaranteed-issue basis. This is free of exclusions
for pre-existing health conditions after leaving an employer
group insurance plan. To qualify for guaranteed issue of non-group,
or individual insurance, a person must have 18 months of prior,
continuous coverage by group insurance. Second, if coverage
on COBRA was available the person must have used all the time
he or she had on that plan. In most states, this period of
time is 18 months. Once COBRA coverage is no longer available,
association and individual health plans must cover pre-existing
conditions. Finally, the person must buy an insurance plan
with in 63 days of leaving the group plan to exercise this
guaranteed eligibility.
In addition, every state has a mechanism for
guaranteed-issue insurance. If you are not eligible, then
there are some other
insurance options. Twenty-eight states operate a "high-risk" pool.
Pool coverage is like group coverage and part of the cost is
subsidized by appropriations from state revenue. Other states
offer guaranteed-issue basic or standard insurance coverage.
In order to find out if your state has one of these opportunities,
contact your department of insurance. An easy way to find an
insurance department is on the Internet. Try the web site of
National Association of Insurance Commissioners (NAIC). In
many states, health maintenance organizations (HMOs) offer
guaranteed-issue insurance. HMOs are much more strict about
whom you see but having coverage of any kind is a need.
In 1996 the laws changed for those people with
pre-existing conditions. Now many people would not be forced
to have no
coverage, they can opt for a plan that excludes the disability
for a brief time. The HIPAA (Health Insurance Portability and
Accountability Act of 1996) determined that there are certain
conditions health insurance carriers may and may not cover.
HIPAA defines a pre-existing condition as: "A condition
(whether physical or mental), regardless of the cause of the
condition, for which medical advice, diagnosis, care or treatment
was recommended or received within the 6 month period ending
on the enrollment date." In effect, insurance carriers
cannot exclude:
- Newborns
- Pregnancy
(even late entrants)
- Adopted
children or children placed for adoption under 18 years
Insurance carriers can exclude:
- People
who have never had health coverage
- People
who previously had health coverage, but in less time than
the plan's pre-existing exclusion period
- People
who are late entrants (basically, people who did not enroll
when they could have)
- People
who have been without coverage for 63 days
However, exclusions are generally limited in
how long they can be excluded: Regular on-time entrants may
only endure an
exclusion period of 12 months following enrollment. Those who
received treatment for a condition 6 months before enrollment,
such as you were treated for melanoma on January 1, 2005: you
can enroll up to July 1, 2005 and still be eligible but you
must wait until July 2006 for benefits to begin. Late entrants
must endure a longer exclusionary period of 18 months, but
maintain the same eligibility requirements for regular on-time
entrants above. HMO's may affix a "waiting" period
of 60-90 days if they have no pre-existing exclusion policies. Click here to to view health insurance quotes, compare plans side-by-side and apply for the most affordable health insurance within your budget. I did this myself (June 17, 2011) to change my health insurance policy. Saved me $84 per month (or $1,008 per year). It's my SolveYourProblem recommendation.
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by SolveYourProblem.com
: 2006
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