Question about health insurance & pre-existing conditions?

Question

Shortly before being taken off of my parent's insurance plan, I was diagnosed with a thyroid condition that requires expensive blood tests and regular office visits. I have applied for insurance through my job, and when reading the bylaws I noticed that it does not cover pre-existing conditions. Will my thyroid disorder be considered a pre-existing when I was diagnosed only a few months ago? Will I ever be able to get any kind of insurance coverage for this disorder now?

Answer 1

I'm sure it will be considered pre-existing, yes.

Answer 2

Most companies have pre-existing clauses - meaning they can deny coverage for certain diagnoses for any period of time they set up to a year.

BUT if you had no lapse in coverage, or less than 63 days, you can send in the letter of termination from your previous plan and most plans waive the pre-existing clause.

Answer 3

Your pre-existing condition will be covered as long as you have had prior "creditible coverage". Below is a link to the federal law governing group health insurance.

Don

http://mtnhealthinsurance.com

Answer 4

If you've had continuous health insurance coverage (no break in coverage over 63 days), then you are fine.  The HIPAA law protects you.  All you have to do is provide your new insurer with proof of sufficient Creditable Coverage from your last policy, and the pre-existing clause should be waived.

If you did go longer than 63 days without health insurance, then you'll have to wait out the pre-existing clause to have coverage for services related to your thyroid condition.  (Anything not related to the thyroid issue should be covered as normal.)  You'll have to pay out of pocket for your thyroid issues for the first 12 months of the policy.  (Or whatever time your policy states...the standard is 12 months, but I've seen policies where its 6 or 9 months.)

After the pre-existing clause expires, your thyroid condition will be covered like normal...that's one of the protections of a group policy through an employer.

(Hopefully you didn't let your insurance lapse though...knowing that you have a medical condition, it would have been wise to have insurance coverage lined up before you were taken off your parents' plan to make sure you didn't have a break in coverage longer than 63 days!)

Answer 5

Not if the lapse in coverage between the two plans is less than 63 days.    As long as you go from one plan to another, with a lapse of less than 63 days, the new plan will pick it up.

But if it's been more than 63 days, you'll have to wait out a time period - usually 12 to 18 months - before the thyroid condition is covered.  Then it will be covered again, and as long as you have no future lapse of more than 63 days, it won't be an issue.

Answer 6

Wow that's odd.  I've never heard of a company having pre-existing clauses for employees.  How much time passed between the time you lost your coverage with your parents and started working.  You may qualify under some federal regulations, whereby, you can have a plan issued w/o pec or underwriting if you apply for it within a certain number of days.  All you need is proof that you lost your coverage through no fault of your own.  You also may want to call your company's benefit department to find out if you're correct.   If so, find out how you can get the pec waived and if Guaranteed Issue is something you can take advantage of.  I wouldn't take their word on it either.  I'd ask an independent agent.   Do your parent's have an agent they can ask questions for you?

Answer 7

Yes, it would be pre-existing.  If it was diagnosed even one day before the new policy took effect, it is definitely pre-existing.  Even if it was diagnosed after the new policy took effect, it might be pre-existing if you had symtoms earlier.

However, pre-existing conditions can only be "not covered" for a certain number of months, which is limited by law, never exceeds the first 18 months of the policy.  For group plans (which nearly all employer plans are), it usually does not exceed 12 months and you get credit for prior coverage through your parent's insurance plan (make sure that you have the required documentation) if the gap between the two is less than 63 days (in other words, no more than 2 months).  Therefore, if you had prior coverage for at least 2 years and the gap is less than 2 months, you should be covered immediately.