Overview of Pre existing conditions

As anyone who has performed research for buying health insurance knows, the devil is in the details. In our earlier article on choosing a private health care provider, we saw how one needs to look out for pitfalls such as pre existing conditions before deciding on a particular plan.

Pre existing conditions seem unfair to those purchasing insurance since it seems to negate the very purpose of insurance in the first place. What is the use after all, of buying insurance when your most pressing medical conditions are not covered?

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The US congress recognized the dangers of health insurance companies refusing coverage of pre existing conditions in 1996 and brought out the Health Insurance Portability and Accountability Act (HIPAA) which limits the ways in which insurers can impose conditions.

Time limits for Pre existing conditions

HIPAA ensures that no insurance firm can deny coverage for a pre existing condition if there was no medical consultation or treatment for a maximum of 6 months prior to coverage being applied for.

This means that in the case of a person suffering from a mild case of diabetes, if there was no formal treatment or contact with a medical doctor regarding this issue for 6 months, then that individual cannot be refused health insurance coverage for that condition on the premise that it was preexisting.

In addition, there are certain conditions cannot be classified as pre existing such as pregnancy and genetic information.

Limits of non coverage

In case you have received treatment or medical advice for your condition within the past 6 months, the insurance provider has the right to refuse you coverage for that condition alone. However, HIPAA places limits on how long such exclusion may apply.

For regular enrollment, the exclusion period cannot extend to more than 12 months and for late enrollment, 18 months. In addition, if you can show that you were covered by a previous health insurance program within 63 days of applying for the new one, you can claim "creditable coverage" and offset the waiting exclusion period stipulated in your new plan.

Such measures ensure that patients are not victimized for existing conditions and receive fair and just treatment.

Summary

While preexisting conditions are an important part of choosing a new plan, it's important to know your rights. HIPAA provides customers with important enabling provisions that ensure that insurance providers do not abuse their discretionary power and helps maintain health coverage for all.

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