Health Plans for Pre existing Conditions

When it comes to health plans for pre-existing conditions, your options will depend on whether you belong to a group plan or you have bought an individual health insurance policy. A pre-existing condition is a medical condition (through illness, injury, or disease) that a person applying for insurance coverage had prior to the insurance coverage coming into force.

Insurance companies may deny coverage based on a pre-existing condition.

Health Plans for Pre-existing Conditions: Group Health Insurance

When you sign up for a group health insurance plan through your work, a professional organization, or alumni association, you cannot be denied coverage due to a pre-existing condition. The company issuing the group insurance plan cannot charge you more for your premiums because of your health, either.

The only thing that the carrier can do in the case of a person who has a pre-existing condition is to add a provision to the policy stating that they will need to wait a certain amount of time before they can get coverage. The maximum length of time an insurer can impose due to a pre-existing condition will vary depending on the state.

HIPAA: Portable Health Insurance

The Health Insurance Portability and Accountability Act (HIPAA) was put into effect to protect Americans who have either lost their jobs or changed jobs. Under the provisions of HIPAA, when a person enrolls in a new group health insurance plan, they get credit for their previous participation.

As long as the applicant has been enrolled in a group health plan for 12 continuous months without a lapse in coverage that lasted for more than 63 days, the new insurance company is barred from declaring that the individual has a pre-existing condition for insurance purposes. Coverage must be extended immediately with no waiting period.

The following types of insurance plans count toward "continuous coverage" under HIPAA:

• A group health insurance plan
• Medicaid
• Medicare
• Health Insurance Offered Under a High-Risk Plan Funded by the State
• TriCare

Under HIPAA, a group health insurance plan can be made up of as few as two people. While the legislation does protect workers by guaranteeing that they will be covered under the new group health insurance plan even if they have a pre-existing condition, the new plan may or may not have a similar level of coverage to the previous one.

Health Plans for Pre-existing Conditions: Individual Health Insurance

If you want to buy an individual health insurance policy, the rules are a bit different. The insurance company can turn down your application outright or decide to charge you a higher premium if you have a pre-existing condition.

Do keep in mind that each company offering health insurance coverage has different underwriting procedures. Underwriting is the process where an insurance company determines your level of risk as far as making claims against your policy. People who are in good health are considered a lower risk and are offered better rates for their health insurance coverage.

Even if you have a pre-existing condition, you may still be able to get health insurance coverage. The insurance company may still extend coverage to you if your condition is stable, is being controlled with medication and you are not likely to have a relapse.

If You Are Turned Down For Individual Health Insurance

Before you start shopping around for another insurance company, ask the one that turned you down for an explanation of the reason why you were turned down. It's possible that the insurance company made an error when their underwriter reviewed your application.

You have the right to get an explanation in writing. Once you receive the insurance company's response, you can decide how to proceed. If the denial was based on inaccurate information, you can bring this fact to the insurance company's attention and ask them to reconsider your application. If not, then you can apply for coverage with a different company.

The way insurance companies deal with health plans for pre-existing conditions varies, depending on whether you are applying for individual or group insurance coverage.

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