Pre-Existing Condition – What it is and how the Health Care Reform is applied to it?
Pre-Existing Condition – What it is and how the Health Care Reform is applied to it?
Many individuals may have the question of what is a pre-existing conditions? There is no one set definition of what a pre-existing condition is, but a pre-existing condition can be a physical or mental health condition, disability or illness an individual has, before they enrolled onto a health insurance policy. Many health insurance companies will use different definitions or criteria depending upon the individual’s condition. It can prevent a person from obtaining coverage or you can be approved for coverage, but it will exclude coverage to benefits that are associated with the pre-existing conditions. The health insurance company may also charge a higher premium due to the fact of the pre-existing condition.
Starting October 1, 2010 under the Affordable Care Act, children under the age of 19, can not be denied coverage or have excluded benefits due to a pre-existing condition. For individuals above the age 19 with pre-existing conditions this same rule goes into effect in 2014.
If you are 19 years or older now, with a pre-existing condition that is keeping you from health coverage or only offering you limited coverage you may now qualify for the Pre-existing Condition Insurance Plan or PCIP. PCIP is the National Health risk pool insurance plan that you heard about when the health bill was being passed. So the national health plan for people who can not get insurance is now in place until 2014. For those individuals who have not had health insurance for 6 months and who have not been able to obtain insurance because of their pre-existing condition, the new Pre-Existing Condition Insurance Plan (PCIP) program will make health coverage available to you. Within this program these individuals will be able to obtain coverage that will include immediate coverage of health care services linked to your pre-existing condition.
Even if you are eligible for the PCIP plan you may have other options available, contact us and we would be happy to help or point you in the right direction.
*The Pre-Existing Condition Insurance Plan is available in every state the exact nature of the plan and how eligibility based on a pre-existing condition is to be demonstrated, may vary depending on your state:
• In some states, the U.S. Department of Health and Human Services is operating the program. (this is the case for Arizona)If this is the case in your state and you have been denied enrollment or coverage of specific benefits due to a health condition and you have had no coverage for 6 months or more, you have a pre-existing condition that makes you eligible.
• Some states are running their own programs. Different states may use different methods of determining whether you have a pre-existing condition.
*Citation: Angoff, Jay “What is Pre-Existing Condition?” Director of the Office of Consumer Information and Insurance Oversight Posted August 18, 2010
With any specific questions please do not hesitate to call us at 480-830-2595 or email us at frontdesk@wearingtoomanyhats.com . If we do not know the answer we will do our best to find out for you. We are staying vigilant on getting all the information as it comes out, so we can better help serve our community with their Health Insurance Coverage.