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What is considered a pre-existing condition?

Couple with preexisitng condition seeks life insuranceSimply put, a pre-existing condition is any medical condition that you had before you purchased health or life insurance.

This can include asthma, epilepsy, mental illness, heart problems, diabetes, cancers, pregnancy, Multiple Sclerosis, allergies, high blood pressure, or even previous injuries. To get insurance quotes from providers just enter your zip code above now!

Insurance companies can legally refuse to include treatments for such pre-existing conditions. You could purchase a policy, and the policy could be more expensive because of your various risks, but you may not get coverage for the things you obviously needed coverage for.

In some cases, the insurance company will not cover treatments for certain pre-existing conditions. For example, if you had a child who was born with asthma, the insurance company may exclude coverage for any asthma-related breathing problems forever.

You might even be asked to sign a waiver saying you understand and accept that exclusion. Other insurance companies might only have a waiting period where, for the first 12 months or 18 months or so, they will not cover anything related to pre-existing conditions. After that period of time is over, they will offer coverage for some of those conditions.

It is, however, possible to switch coverage without having to deal with pre-existing conditions. If you have had health insurance for at least 18 months without a gap of more than 63 days in coverage, the new company will waive those waiting periods.

Patient Protection and Affordable Care Act

The law is in a current state of flux right now. The Patient Protection and Affordable Care Act (signed into law in March 2010) eliminates pre-existing condition requirements. Beginning in September of this year, insurance companies are forbidden to deny coverage to children with pre-existing conditions that does not include treatments for those conditions. The Act includes many other health care reforms, but this is one of the major ones.

This policy provision will apply to everyone in 2014, which gives health insurance companies time to work out some of the details of their policies. At that time, insurance companies may be able to make note of your pre-existing conditions, but they will not be able to deny you coverage all together because of them, or be able to deny to cover any costs related to them.

Until then, however, all the current pre-existing condition exclusions are still in effect—which means it can be totally possible that some people will go the next four years without health insurance. You can obtain health insurance quotes online to help navigate this process.

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If you get insurance with your company, things may be different. You may still have a pre-existing exclusion period, but it will be limited to no more than 18 months (and no more than 12 in most cases). It will also only apply to illnesses or conditions for which you sought treatment in the past six months. So, even if you had a host of pre-existing conditions, if you had not seen a doctor for any of those conditions in the past six months, you will be fully covered by your employer’s health plan.

The Health Insurance Portability and Accountability Act (HIPAA) was passed by Congress in 1996. It is because of HIPAA that you are able to enroll in a new health insurance plan without being subject to waiting periods if your previous coverage had not been interrupted for more than 63 days. HIPAA also put limits on pre-existing conditions exclusions, among other things.

However, it does not work in all cases. For example, HIPAA is supposed to prevent a company from being able to apply pre-existing conditions exclusions to pregnancy, but it does not apply to all individual health plans.

In fact, it is almost impossible to get coverage for a pregnancy if you apply while pregnant—many plans will also say they will not provide any coverage if you get pregnant within the first 12 months. Group plans may have similar, but not as extreme, provisions about pregnancy (shorter probation periods, for example).

Life Insurance and Pre-existing Conditions

Obtaining life insurance with a pre-existing conditions is a very similar process. In some cases, you cannot obtain coverage if you are already ill or diagnosed with cancer. In some situations, you will be written a policy but it will exclude the specific pre-existing condition. Even in this situation, you may wish to purchase a policy for the protection it offers to your loved ones if you die from an unrelated factor.

To obtain most types of life insurance plans you will need to complete a medical questionnaire or take an exam to determine the risk you represent to your insurer. If you do have a pre-existing condition like lung or kidney disease, cancer or a host of others chances are you will have a two year window. If you die in that timeframe from that disease the company will not pay out.

The best thing to do is to ask questions and figured out what is covered for both life and health insurance. Also, know that each state has a state-sponsored individual health insurance plan for people who are unable to get other coverage because of pre-existing conditions. You will pay more for health insurance this way, but you will not be denied basic coverage (you will still, however, face waiting periods).

Use free online quote tools like the one found here on this page to help you get an idea of what you can expect to pay for insurance. Though it may be harder to find coverage now than it will be in 2014, you may be surprised to find out that things may be much more affordable than you anticipated. To get online insurance quotes use the free tool today!

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