Pre-existing Conditions And Your Health Insurance Coverage
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One thing that will have a major impact on the price of your health insurance coverage is your "pre-existing conditions." In the most general terms, this means something that you have been treated for in the past. But, how can you tell if something should be considered a pre-existing condition or not.
What Are Some Pre-Existing Conditions
A pre-existing condition can be any injury, illness, sickness, disease, or nervous or mental condition. If you have sought or received any medical advice, diagnosis, care or treatment for the condition in the past, you must tell your insurance provider.
The law states also that any condition which a reasonable person should have sought treatment for, even if you didn't, is technically a pre-existing condition.
If you had a disease but were unaware of it prior to your enrollment, that is not considered a pre-existing condition. You had to have been fully aware of the condition. Genetic factors which would make you prone to a certain disease are also not considered pre-existing conditions.
The more recent the medical help, the harder you can expect it to be to get it covered. A recent hospitalization or treatment will make insurance companies more nervous. If you have sought medical attention in the last year or so, it may be difficult to find a plan that will cover you.
Exclusions May Keep You From Being Fully Covered
Different companies have different pre-existing condition exclusion periods. This means that for a specified time after your enrollment in the health plan, they will not cover costs incurred due to your pre-existing conditions.
A private health insurance provider has the right to exclude any pre-existing conditions from coverage in a basic plan. State-sponsored healthcare plans do not have the right to do so. A private company may pile on lots of extra dollars in premiums if they consider your pre-existing condition a major risk.
If your insurance company doesn't cover your major health problems, then what's the point of getting insurance? You have to look at it from the company's point of view. Covering pre-existing conditions is, for them, a definite loss of money. They insure you against the probability that you will not develop major health problems. That's the way insurance works.
This is why it's important to get health insurance while you are still young and healthy. If you have a group plan, or carry a policy for a long period of time, you will be safer. If you change policies, there are guidelines that allow you to roll your insurance policy over into a new one, including coverage of health conditions that have developed more recently.
Tell Your Insurance Agent Everything
You have to be up-front with your insurance provider about your pre-existing conditions. If they find out later that there was something you didn't mention, they can rescind your insurance policy instantly, and you have no say over it.
Rules and regulations regarding pre-existing conditions vary from state to state. Check with the state in which you live and see what laws apply to you.
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Ask Addie says:
2 years ago
Great Hub and good advice! I have a condition and was lucky to have insurance. I was self employed and know others who are and did not feel it was inportant to spend the money on insurance. Thank god I did! Although, something needs to be done with the rising costs.....even with health insurance, between my ridiculously high premium and co-pays, I wonder how great is it?