Pre-Existing Condition Insurance Plan..

By: Taylor

The term ‘pre-existing condition’ is a known term to both consumers seeking health insurance and health insurance companies. It refers to a medical condition a consumer had prior to obtaining (or seeking) medical insurance coverage. In the past, insurance companies would systematically deny coverage to individuals with a pre-existing condition, or would allow the consumer medical insurance, however would not cover any form of treatment for the pre-existing condition – either for a specified period of time, or not at all.

That changed with the formation of the Pre-existing Condition Insurance Plan. Launched in 2010, the PCIP program was designed by our government and the Department of Health and Human services as a way for those with pre-existing medical conditions, who had been without insurance for a period of six months and had been previously denied health insurance due to their pre-existing condition.

Enrollment in the program was suspended on February 16, 2013 to ensure that funds would be available to continuously cover the health care costs of the more than 100,000 Americans that had already enrolled in the program. The PCIP program is run by the United States Department of Health and Human Services and was not available in every state.

Those currently enrolled in the PCIP program will have their health insurance coverage ending as of December 31, 2013 and will have to enroll in a new medical plan. For more information on this, see our page on PCIP Coverage Ends on Dec 31, 2013.

Pre-existing Conditions

There is a variety of medical conditions that fall under the heading of ‘pre-existing’ some of those conditions include – but are not limited to”

Depression and other mental health issues
Chronic Heart Disease
Kidney Disease
The list goes on and on, however it’s important to note that before the Affordable Care Act, each individual insurance company had their own proprietary list of medical conditions which they deemed would fall under the heading of ‘pre-existing’. Therefore some consumers would find they were denied coverage from one company for a pre-existing, yet might have found coverage with another insurer which did not have the consumers condition on the pre-exiting list.

Obtaining Health Insurance Coverage with Pre-existing Conditions

Before the Affordable Care Act, most health insurance companies would require a newly insured individual to go through a waiting period before the insurance would cover any aspect of care for a pre-existing condition – this included prescriptions and medical office visits, tests, treatments and so on.

Most insurance companies will require all new insured to wait a short period of time after purchasing health insurance – typically 30 days – before coverage begins. However, with a pre-existing condition, those same insurance companies will cover all medical expenses with the same waiting period (exclusion period) – except those concerning the pre-exiting condition, which can have a waiting period of up to a year.

Now, with the Affordable Care Act, insurance companies are no longer allowed to deny coverage to individuals with pre-existing conditions, nor are they allowed to charge higher premiums to those with pre-existing conditions. In fact, under the Affordable Care Act, some of the treatments for pre-existing conditions fall under the Essential Benefits Package – which means that they are covered 100% with no copay or coinsurance cost.

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