A pre-existing condition is any medical situation that occurred or is under treatment prior to joining a new health insurance plan. In the past, insurance companies were able to exclude the condition or apply a long waiting period before they would pick up expenses related to the existing condition. With the enactment of HIPAA (Health Insurance Portability and Accountability Act of 1996), many previously uninsured individuals can now receive coverage for pre-existing conditions.
Thanks to HIPAA, group health insurance companies can no longer exclude all pre-existing conditions across the board. While this is good news for individuals who are switching health insurance companies, it's best to become more familiar with the coverages afforded under HIPAA. Be sure to satisfy the following HIPAA requirements:
Proof of Continuous Creditable Insurance Coverage
In order to have a pre-existing condition covered, the applicant must provide proof of continuous creditable insurance coverage. Some insurance companies require at least 12 months of prior coverage before providing insurance on pre-existing conditions. Creditable insurance includes coverage under a prior group health plan, COBRA, Medicaid, Medicare or an individual health plan.
Be advised, however, waiting periods don't count. If, while covered under the prior plan, the applicant was in the "waiting period" stage, meaning, the individual applied for group health coverage but had to undergo a 30 or 60 day waiting period before coverage goes into effect, the 30 or 60 day period of time does not count towards creditable insurance coverage.
Proof of coverage comes in the form of a Certificate of Creditable Coverage or a Statement of Insurance from a prior insurer. The certificate is issued automatically and free of charge to individuals who lose coverage. If for some reason the applicant does not have proof of insurance, she may request it from the prior group health insurance company up to 24 months from the time of coverage termination.
Gaps in Health Insurance Coverage
One of the requirements under HIPAA is that creditable coverage must be continuous. Continuous coverage means having a gap in health coverage of no more than 62 days. If the gap in coverage is 63 days or more, any insurance in effect prior to the gap in coverage may not be counted towards continuous creditable insurance. The date that the coverage gap ends, in essence, is the new starting point for continuous creditable insurance.
For more information on HIPAA and its affect on the pre-existing conditions exclusion, visit the US Department of Labor website.
Felicia A. Williams - Felicia A. Williams is a full time freelance writer with over 20 years of business writing experience.
