Health Insurance Articles

What are Pre-Existing Conditions, and Can I Get Them Covered?

2009-02-09

What are Pre-Existing Conditions, and Can I Get Them Covered?

We have all heard the term "Pre-Existing Condition," but not everyone knows what it means and how it affects health insurance coverage. Most health insurance plans have a Pre-Existing Condition clause that states that they will not cover any pre-existing condition for a set amount of time after the start of a new health insurance plan. Insurance companies do not want people waiting until they are diagnosed with an illness to seek out health insurance coverage. To discourage this, many have pre-existing condition clauses in the policy. Everyone needs health insurance coverage, even if they do have a pre-existing condition.

Pre-Existing Conditions

What kinds of conditions can fall under a pre-existing condition? To put it simply, a pre-existing condition is any medical condition that has existed or was diagnosed before you obtained health insurance coverage. In most cases, there is a 12 month waiting period before your insurance company will cover any expenses related to your pre-existing condition. Upon obtaining health insurance coverage, the insurance company is only allowed to review your medical records up to six months prior to you obtaining a new health insurance policy. If you were not treated for or received any medical advice in regards to your condition in the six months prior, it is no longer considered a pre-existing condition.

There are many common pre-existing conditions, and if you are ever in doubt always be honest and ask. Several of the most common include:

• Cancer
• AIDS/HIV
• Heart disease
• Asthma
• Back ailments
• Pregnancy - Often times the baby will be covered under the plan once it is born, but pregnancy itself would not be. But under HIPPA, pregnancy can not be considered a pre-existing condition, but under non-HIPPA regulated plans it can be.

Are You Covered and Not Know It?

If you have a pre-existing condition that was treated in the past six months, you can still be eligible for health insurance coverage. A health insurance plan can waive the waiting period on any pre-existing conditions, as long as you had creditable coverage prior to obtaining the new policy. Credible coverage would be participation in a group health plan, COBRA continuation coverage, Medicare and Medicaid, along with coverage through an individual health insurance plan. Your previous plan will be considered credible coverage as long as you have no gap that is longer than 63 days. If the gap in your coverage was shorter than 63 days, than any health insurance coverage that you had prior can be used to offset any pre-existing condition exclusion period. Days spent in a waiting period for new coverage can not be counted as credit, and they are also not counted toward the significant break of 63 days or less.

Options for Pre-Existing Condition Insurance

If you do have a pre-existing condition, and do not qualify for any kind of creditable insurance coverage, you do still have options for health insurance coverage. Many companies specialize in high-risk and short-term policies that are meant for individuals who need health insurance now. There are many different options to find coverage, and the worst thing that you could do is be dishonest or cover up an ailment. If your new insurance company discovers that you have lied, they may continue to take your premiums but refuse to pay anything in relation to the ailment.

At HealthInsuranceCoverage.com we have policies that can be tailored to your specified health insurance needs. Our health insurance quotes are always free and we will provide you with a competitive quote quickly.