Pre-existing Conditions and Health Insurance

Pre-existing condition is a term with which many insurers and insured individuals are familiar. This type of condition relates to a medical issue which was present prior to one obtaining their health insurance policy. There are often negative connotations associated with the term pre-existing condition as it is something which may prevent you from obtaining health insurance coverage or make it more likely that you will pay a costly premium when coverage is obtained. However, those who are interested in obtaining health insurance coverage and do in fact have a pre-existing condition will feel better in knowing that there are insurers who will provide them with coverage although there may be certain restrictions.

Types of Preexisting Conditions

There are various forms of pre-existing conditions. Some of the more common ones include pregnancy, obesity, arthritis, diabetes, depression and fibromyalgia. Each individual insurance company will compile their own list of pre-existing conditions and have their own standards when it comes to providing insurance coverage for those who are stricken with these conditions.

Obtaining Health Insurance Coverage with Preexisting Conditions

Frequently health insurance companies will require new insured's to undergo a waiting period before having their pre-existing conditions covered under the health insurance policy. Many insurance companies which offer individual health insurance policies require a waiting period of 12-18 months before they will pay medical bills related to pre-existing conditions. The good news is that there are certain protections allotted to those with pre-existing medical conditions. Under HIPAA, the Health Insurance Portability and Accountability Act, you are entitled to have your pre-existing medical condition treatments paid for by the new company. Under this act, those who have previously been insured under a group health insurance plan and are obtaining a new type of health insurance may be able to have their pre-existing conditions covered so long as they meet certain criteria.

It is important to note that HIPAA relates to individuals who have been previously insured under a group health plan and not an individual health insurance policy. With that said, should you fall into this category, take advantage of HIPAA when switching from a group policy to another group policy. This will prevent you from having to pay for costly insurance due to a pre-existing condition or having a hard time obtaining health insurance altogether.

Alternative Health Coverage Options


There are other alternatives for those with pre-existing conditions who are looking to obtain individual health insurance. Most states have high risk insurance pools which provide coverage, albeit expensive coverage, to individuals with pre-existing conditions.

Source: Medindia