Health insurance coverage for pre-existing conditions is part of the national health care reform debate. A pre-existing condition is any disease or illness which is diagnosed prior to enrollment in a health insurance plan. Many plans have specific rules regarding coverage for previously diagnosed conditions for new insureds. Typically, the plan will not provide benefits for the pre-existing condition for a set period of time. The exclusion period may be anywhere from 12-18 months.

Most consumers do not understand that there is a certain time period that an employer-based health plan reviews to determine what would be considered a pre-existing condition. By federal law, an employer-based health insurance plan can only deem a condition pre-existing if the diagnosis and/or treatment occurred within the prior 6 months to taking out the coverage. So, for example, if you were diagnosed with hypertension 2 years ago, but have not received any treatment in the 6 months prior to enrolling in your health plan, the hypertension is not considered to be a pre-existing condition. On the other hand, if you had problems with your blood pressure which required treatment within the last 6 months, your hypertension is considered to be pre-existing.

Individual health plans do not follow federal regulations regarding pre-existing conditions. These plans are regulated by state law. Individual plans may review several months, or several years of medical records. If you have medical conditions for which you require routine treatment, you will want to review the pre-existing conditions clause of the health plan.

Tags: Health Insurance, health insurance coverage, Pre-existing Conditions

This entry was posted on Tuesday, October 6th, 2009 at 9:20 am and is filed under Health Insurance, Health Insurance Plans. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.