A preexisting condition generally refers to any health condition that you have had prior to enrolling in a current health plan.
Being in the business of making money, insurance companies try to discourage people from waiting until they get sick in order to acquire medical insurance. One way in which they do this is to impose preexisting condition exclusion periods. This means that if you have a medical problem which exists at the time you enroll in or purchase a medical insurance, the insurance company will deny all claims pertaining to this medical problem for a certain period of time.
In availing of medical insurance even with preexisting conditions, it is important to note that you have the right to not be denied coverage on the basis of your health status, medical condition or history, genetic information, disability or insurability. You have the right to receive coverage for preexisting conditions in most cases within 12 months (or, in some instances, 6 months) of enrolling in a health care plan. If you are enrolling in an individual plan, you also have the right not to be denied coverage if you have had 18 months of continuous coverage previously and meet certain other requirements. You have the right to be credited for time enrolled in a previous plan against any preexisting condition waiting period.
Acceptance is guaranteed. Benefits include doctor visits, hospital stays, prescriptions, surgery, blood tests, x-rays, emergency room services and much more. Even if you already have health insurance, our services can lower your monthly premium and increase coverage.
The length of any preexisting condition exclusion period will be shortened by giving you credit for time that you were previously covered under certain prior medical insurance plans. Specifically, if you are eligible to begin coverage under a new employee group health plan within 62 days of having been terminated from prior coverage under another individual or group health plan, Medicare, Medicaid, or other publicly-sponsored medical care program, then your new health plan must credit any time that you were previously covered towards the preexisting exclusion period.
In general, when you are buying medical insurance health plan (insurance sold outside the employer group market), you cannot be denied health coverage nor be subject to an exclusion period for a preexisting condition if you have had a total of 18 months of continuous "creditable coverage" which means health insurance coverage without a break of 63 or more consecutive days. In addition, you must have used up any COBRA or state continuation coverage and you must not be eligible for Medicare, Medicaid, a state program, or a group health plan. You also must not have other health insurance and you must apply for individual health insurance within 63 days of losing your prior creditable coverage.
When you are still denied medical insurance due to a preexisting condition despite meeting the aforementioned conditions, you can file grievances with your health plan. You may also have the right to obtain a review of your plan's decision through an independent review process.
Another alternative is to sue your health plan. While a health plan may deny you coverage as part of its overall restrictions on certain benefits as they are applied to all enrollees, it may not deny coverage of your preexisting condition in violation of the governing federal and state statutes.
If you are unable to obtain coverage on the open market due to a serious health condition, you may be eligible for coverage under the state risk pools. Health care is provided through contracts with various health plans. Participants in the program are responsible for the cost of program premiums.