Tips On Finding Health Insurance Even With Pre-existing Medical Conditions

How much coverage you can get on a pre-existing condition varies from state to state. For people getting insurance through their job, it is illegal for them to not let you join the plan based on a pre-existing condition. As long as you are an employee, you have the same rights as all other employees to the group plan and rates. The Health Insurance Portability and Accountability Act, also known as HIPAA, also grants limited eligibility for continuous coverage for employees who leave their employer, through COBRA laws. If certain conditions are met, such a person can obtain health insurance in the individual market on a guaranteed-issue basic like every one else.

Most insurance companies consider pre-existing conditions as health conditions that you already have gotten or are receiving treatment for. Pregnancy, AIDS, high-blood pressure and stroke are all considered pre-existing conditions. Each insurance carrier has their own policies and procedures regarding pre-existing conditions. Some have waiting periods while others totally won't cover certain conditions. Having a pre-existing condition obviously puts you at a higher risk for compensation than people without pre-existing conditions, but that doesn't necessarily mean you can't get insurance.

HIPAA tells you the conditions under which a person who maintains continuous insurance coverage is able to purchase individual insurance on a guaranteed-issue basis. This is free of exclusions for pre-existing health conditions after leaving an employer group insurance plan. To qualify for guaranteed issue of non-group, or individual insurance, a person must have 18 months of prior, continuous coverage by group insurance. Second, if coverage on COBRA was available the person must have used all the time he or she had on that plan. In most states, this period of time is 18 months. Once COBRA coverage is no longer available, association and individual health plans must cover pre-existing conditions. Finally, the person must buy an insurance plan with in 63 days of leaving the group plan to exercise this guaranteed eligibility.

In addition, every state has a mechanism for guaranteed-issue insurance. If you are not eligible, then there are some other insurance options. Twenty-eight states operate a "high-risk" pool. Pool coverage is like group coverage and part of the cost is subsidized by appropriations from state revenue. Other states offer guaranteed-issue basic or standard insurance coverage. In order to find out if your state has one of these opportunities, contact your department of insurance. An easy way to find an insurance department is on the Internet. Try the web site of National Association of Insurance Commissioners (NAIC). In many states, health maintenance organizations (HMOs) offer guaranteed-issue insurance. HMOs are much more strict about whom you see but having coverage of any kind is a need.

In 1996 the laws changed for those people with pre-existing conditions. Now many people would not be forced to have no coverage, they can opt for a plan that excludes the disability for a brief time. The HIPAA (Health Insurance Portability and Accountability Act of 1996) determined that there are certain conditions health insurance carriers may and may not cover. HIPAA defines a pre-existing condition as: "A condition (whether physical or mental), regardless of the cause of the condition, for which medical advice, diagnosis, care or treatment was recommended or received within the 6 month period ending on the enrollment date." In effect, insurance carriers cannot exclude:

�Newborns

�Pregnancy (even late entrants)

�Adopted children or children placed for adoption under 18 years

Insurance carriers can exclude:

�People who have never had health coverage

�People who previously had health coverage, but in less time than the plan's pre-existing exclusion period

�People who are late entrants (basically, people who did not enroll when they could have)

�People who have been without coverage for 63 days

However, exclusions are generally limited in how long they can be excluded: Regular on-time entrants may only endure an exclusion period of 12 months following enrollment. Those who received treatment for a condition 6 months before enrollment, such as you were treated for melanoma on January 1, 2005: you can enroll up to July 1, 2005 and still be eligible but you must wait until July 2006 for benefits to begin. Late entrants must endure a longer exclusionary period of 18 months, but maintain the same eligibility requirements for regular on-time entrants above. HMO's may affix a "waiting" period of 60-90 days if they have no pre-existing exclusion policies.