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Pre-existing Conditions and Health Plan Laws

Audrey M. Jones
Insurance Files

A pre-existing condition is one that an individual has suffered from for a period of time prior to seeking health insurance coverage. Previously, having a pre-existing condition could determine what types of health insurance coverage an individual could obtain, the price they paid for coverage, and could also lead to higher insurance premiums, coverage exclusions, or a denial of an application. However, these impacts are no longer allowed as of January 1, 2014.

What Is a Pre-Existing Condition?

The category of pre-existing conditions includes chronic illnesses. Historically, an insurance company determines what is a pre-existing condition for each applicant based on the applicant's medical history. Because of this, there is no specific list of what is considered a pre-existing condition. However, illnesses and injuries that may fall under this category include:

  • Cancer
  • Arthritis
  • High Cholesterol
  • Asthma
  • Obesity
  • Hypertension
  • Depression
  • Anxiety
  • Pregnancy
  • Acne
  • Heart Disease
  • Old Sports Injuries
  • Diabetes

Traditionally, the objectiveness in deciding what is a pre-existing condition and the impact of these conditions on policies may mean that individuals having a pre-existing condition must acquire special insurance.

The Patient Protection and Affordable Care Act

The Patient Protection and Affordable Care Act (PPACA) was signed into law by President Obama in 2010. Under this law, insurance companies were no longer permitted to deny coverage, require a waiting period or charge more to a person under the age of 19 who had a pre-existing condition.

The Future of Healthcare and Pre-Existing Conditions

The days of worrying about whether you'll be able to obtain health insurance or will be required to pay more for coverage because of a pre-existing coverage are coming to an end. The result should be that more individuals have coverage and that coverage will be provided for all illnesses and injuries, regardless of when incurred.

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Pre-existing Conditions and Health Plan Laws