Health Insurance Articles
Recurring Illnesses And How Healthcare Insurance Covers Them
2010-07-20
A recurring illness or pre-existing condition is an illness for which the patient receives treatment on a regular, continuous basis. Typically, health insurance coverage providers limited the number of covered visits or placed a maximum on medical interventions to, for example, five occurrences in a calendar year. Other companies instituted a dollar amount limit, such as $5,000, for the insured's entire lifetime. A recent health reform law, however, substantially changed how an insurer can limit coverage for a recurring illness.
Prior to June 2010, patients with recurring illnesses or preexisting conditions had little recourse in obtaining health insurance coverage. Many patients with serious illnesses such as cardiac dysfunction, emphysema, multiple sclerosis, mental health issues, cancer, asthma, or arthritis could not qualify for coverage and had to face critical and consequential financial hardship by self-paying for physician visits, treatments and medications. Many health insurance policies were canceled because the recurring treatments or care exceeded policy limits and continuation of coverage would translate into a financial deficit for the insurance company. It would negatively affect revenue, resources and assets. Most patients had to resort to state-funded health insurance coverage through Medicare or Medicaid in order to remove obstructions to adequate medical care and prescriptions used to manage or accommodate their illnesses. This was a particular concern for parents with children who had recurring illnesses.
As of September 23, 2010, health insurers will no longer be permitted to exclude children with recurring illnesses, the first phase of the health reform law. The plan does not completely go into effect until January 1, 2014. However, in the interim, health insurance coverage will be available for adults and children suffering from recurring illnesses through a national high-risk insurance pool, which also recently became effective.
Health insurance coverage is now available for persons with recurring illnesses through the national high-risk insurance pool. The expected premium is projected to be a fairly reasonable, with a standard, equitably consistent monthly amount, the same that would be assessed for any population with miscellaneous risks. This health insurance is available to anyone with a recurring illness or preexisting condition, as well as those who have not been insured for the past six months. Policyholders will receive subsidies to offset the cost of the premium; the maximum annual cost is $5,950 for an individual policyholder and $11,900 for a family.
Under HIPPA, the insurance company can only consider medical treatments received in the past six months and may issue a limited exclusion usually from 12 to 18 months. Additionally, health insurance providers may not exclude pregnancy or genetics. The new health reform bill requires an extension of health insurance coverage to include recurring illnesses.
