Pre-existing conditions

Pre-existing conditions and how they affect your policy

Everyone wants to make sure that they and their family are financially sound and secure. That is why we always look for different insurance plans, especially health care plans. But having little knowledge about these can be dangerous as this can lead to wrong decisions.

In this article, we are going to discuss a very commonly used term which is pre-existing conditions. What are pre-existing conditions, and how do they affect the policy? We are going to cover all your questions related to this topic.

What is a pre-existing condition?

First things first, let us make you familiar with the concept of “pre-existing conditions”. Any medical injury that existed before you started with your health care plan can be referred to as a pre-existing condition. Now, these conditions may vary depending on the passage of time these were present.

These may be chronic or long-term. Some of the examples of pre-existing conditions are conditions like diabetes, COPD, cancer, sleep apnea, hypertension, asthma, tuberculosis, congestive heart failure, and many others. Any such condition for which a licensed physician was consulted or for which you had to seek treatment or six-month prescription or a condition whose symptoms convinced you to look out for medical help from a qualified medical doctor.

Also, pre-existing conditions are normal.  Around 27 percent of nonelderly adults have these pre-existing conditions, and around 45 percent of the families nationwide have at least one nonelderly member with such a pre-existing condition. This counts as almost 54 million people nationally. Almost all the insurance plans cover pre-existing conditions, so you do not need to worry a bit.

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How are pre-existing conditions determined?

Generally, a pre-existing condition can be related to any treatment that you have received in the past before getting enrolled in that particular health care plan. Before the year 2010, there were very different criteria for determining pre-existing conditions, and the aftermath used to be peculiar and different. An insurance company usually checked your application before enrolling you in the program. If your condition qualified as a pre-existing condition, they had full rights to deny you the insurance plan or even sell you at inflated prices. This does sound like a nightmare for the people who are going through a pre-existing condition. But after 2010, ACA changed it all by making some amendments. And the good news is that in the present time, denying the insurance plan to anyone who has a pre-existing condition is illegal.

What are some examples of pre-existing health conditions?

Pre-existing conditions vary vastly, starting from severe medical conditions like cancer to hormonal problems like acne. Pre-existing conditions include medical illnesses like Parkinson’s disease, hypertension, diabetes, cancer, scleroderma, etc. These even include mental illnesses like depression as well. Pregnancy before enrolment also comes under the category of pre-existing conditions. Other normal conditions such as menstrual irregularities, acne, anxiety can also be categorized as pre-existing conditions.

Can I be denied health insurance if I have a pre-existing condition?

No, not. You cannot be denied any health insurance because of a pre-existing condition unless and until you had gotten yourself enrolled in health insurance before 2010. Before 2010 denying any health insurance or charging conventionally high rates was legal. But after certain amendments under the “Affordable Care Act” in 2010, it was made illegal. Now, due to no type of pre-existing condition, can your insurer deny you health insurance. People enrolled in plans before 2010 are enrolled in the “Grandfather plan”. The insurer, in such cases, can deny the right to coverage or charge high prices on the insurance. Though, you may be charged high depending on the other terms and conditions of your policy. So make sure you go through every single term of condition thoroughly. It is still legal as the enrolment was done before 2010. It is always necessary to make sure that you know everything to the core about the insurance plan you are planning to opt for. Not just thorough knowledge of the insurance plan is required, but you even need to make sure that you are aware of any afresh amendments in the insurance laws.

Is pregnancy considered a pre-existing condition?

No, not. Pregnancy is not at all considered a pre-existing condition. Let’s assume that you have gotten yourself enrolled in a health insurance program and you are pregnant. This means that your insurer or the insurance company can in no case deny you coverage or charge you high than the current prices. The coverage for pregnancy is counted from the day you get yourself enrolled in the program.

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Is there insurance for pre-existing health conditions?

It has been illegalized to deny insurance policies or charging high rates based on your pre-existing medical conditions. Therefore, you can not be denied any health insurance. However, there may be better insurance plans for you based on your pre-existing conditions. So, overall, it would be wise to declare that you have a particular pre-existing condition before enrolling yourself in a health insurance program as the company or your insurer may provide you with better health insurance policies that may vary depending on your pre-existing condition. For instance, if you require regular medical care, time to time surgeries, or maybe an important implant, it would be pretty advisable to choose an insurance program that has a little higher monthly premium and lower deductibles.

Could my plan have a pre-existing condition waiting period?

There are no such waiting periods for medical plans or pre-existing conditions. While looking for the appropriate medical plan, give preference to your medical needs and present medical condition. For example, if you are prone to some chronic disease, then go for a regular medical support plan.

We hope that by providing the above present information, we could clear your doubts and queries.
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