For example, if you purchased a plan six months into your pregnancy and require Pregvit vitamins or hospital accommodations, your plan will not cover the costs if it has a pre-existing clause.
If you are coming off a group plan and go into a guarantee issue plan, your pregnancy would be covered. Every plan is different. It’s important to know the facts about clauses such as this, so you can be prepared should you encounter any difficulties with your claims.
What is a Pre-Existing Condition?
A pre-existing condition is a health condition that you are aware of having before purchasing a health insurance policy, for which you would have experienced symptoms or sought medical attention for in the past. Regardless of the diagnosis, your insurance provider will need to know about the visit in case the symptoms you were asking about develop into something that will need more medical attention.
Pre-existing conditions can range from high blood pressure to past instances of cancer. Usually, if you are still experiencing symptoms or are being treated for a pre-existing condition, any treatment in relation to it will not be covered, but plans vary.
Your pre-existing condition is not something you should omit from your application, as that is a fraudulent act and will void your policy. It’s much better for everyone if you tell the whole truth, and leave nothing out.
What Are the Implications?
The reason insurance companies need to know about your pre-existing condition is so they can determine what the risk is to insure you. When you have a condition that requires a lot of treatment, it costs more for the company to keep you covered. This is why some plans require you to fill out a questionnaire about your health.
Don’t worry; having such a condition will not necessarily prevent you from having coverage. Many of the plans that have a pre-existing condition clause will allow coverage, but only for medical conditions diagnosed after your plan is in effect.
The insurance company will decide if they will take you on as a client. You can get coverage for a pre-existing problem, but in some cases you may have higher insurance premiums to pay every month, or you may be limited to a certain kind of plan.
If you originally had a health insurance plan through your employer, you probably never had to worry about the pre-existing conditions clause. But let’s say you retired or were no longer eligible for benefits under that plan. You would then need to purchase one for yourself, which would in theory be new territory for you.
If you are coming off one plan and trying to get another, one thing to watch for is that some plans will require that you apply within 60 or 90 days of leaving the group plan for guaranteed acceptance. On top of that, you will have to find out if the pre-existing conditions limitations will apply to the plans you’re thinking of purchasing. If you are moving from one individual to another plan, there may not be as many choices, or high maximum options offered.
It’s important to get as much information as possible about the plans you’re looking at. When you do your research, you might find that a guaranteed acceptance plan is ideal for your case. These types of plans will cover you regardless of your medical history. You will not be required to have a medical exam or fill out a questionnaire in order to qualify.
These plans will still have eligibility requirements, such as the maximum time period between coming off a group plan and purchasing the new one, and some may only be available to those who had previous coverage. If you speak with an insurance broker, they will be able to give you all the information you need in order to make a decision, as well as assist you in purchasing the plan.
Another route you can explore is to apply for coverage with a plan that does not offer guaranteed acceptance. If you have a pre-existing condition, your qualification for coverage may be more difficult to get, but that doesn’t mean you shouldn’t try.
A non-guaranteed acceptance plan will require that you complete a medical questionnaire and once it’s completed, the insurance carrier will look at it carefully and determine whether or not you will qualify. They will look at what pre-existing condition(s) you have, the plan you are wishing to purchase, and will then determine whether they will offer you coverage.
Depending on your condition, you may be eligible for coverage, but with exclusions. This means that any services or items related to your pre-existing condition will be excluded under your plan, but all other eligible treatments for ailments not related to your condition will be covered.
For example, if you have pre-existing diabetes, your coverage will look like this:
- Insulin will not be covered
- Needles, test strips, will not be covered
- Medications in relation to diabetes are not covered
- Any other eligible services that are NOT related to diabetes are covered
Another thing to consider is that the non-guaranteed acceptance plan may not accept you at all based on your medical questionnaire. In this case, it’s recommended that you pursue a guaranteed acceptance plan. You may get a counter-offer with a plan that you actually qualify for.
Purchasing a Health Insurance Plan
It can be overwhelming to shop for a health insurance plan. There are many things to consider, different options, and lots of different conditions attached to them. If you have a pre-existing condition, it can seem doubly intimidating, but there’s nothing to fear.
If you are leaving a previous policy, make sure that you start looking for another plan immediately. This will improve your chances of finding (and qualifying for) the perfect plan for you.
Familiarize yourself with the terms of the plans you are looking at. If you call us today, our customer service representatives can work with you to find out what you need and review your options. They are the experts in the field, and will help you find the best plan for you.
An insurance broker can make sure that your needs are addressed and that you don’t have any surprises when the time comes to file a claim. Our brokers are your allies and can advocate for you. Don’t let a pre-existing medical condition stop you from applying for insurance. We can help you today; all you need to do is call.