pre existing conditions

before 2014, health insurers in the individual market (ie, coverage that people buy themselves, as opposed to obtaining from an employer) used medical underwriting in nearly every state. a pre-existing condition is a health issue that required diagnosis or treatment prior to an applicants’ enrollment in a health plan. beginning in 2014, the affordable care act (aca) made it illegal for aca-compliant major medical plans to deny applicants coverage due to a pre-existing condition. so in most cases, insurers doing business today will not require applicants to fill out medical questionnaires or disqualify applicants due to a health issue.

post-claims underwriting can also be used by these non-aca-compliant plans, meaning that they’ll accept most applicants with little in the way of upfront underwriting, but will then do a thorough check of the person’s medical history if and when they have a medical claim; if the condition is determined to be pre-existing, coverage can be denied. the law also eliminated waiting periods that used to apply to coverage for pre-existing conditions on employer-sponsored plans. and within a large group, pre-existing conditions cannot be used to adjust premiums or coverage for a specific member of the group. grandmothered and grandfathered plans in the individual market can continue to exclude pre-existing conditions or impose higher premiums on people with pre-existing conditions, but these plans have not been sold to new applicants for several years (since march 2010 for grandfathered plans, and since late 2013 for grandmothered plans), so these are longstanding exclusions or rate adjustments that can continue to exist.

in the context of healthcare in the united states, a pre-existing condition is a medical condition that started before a person’s health insurance went into effect. [5] regulation of pre-existing condition exclusions in individual (non-group) and small group (2 to 50 employees) health insurance plans in the united states was left to individual u.s. states as a result of the mccarran–ferguson act of 1945 which delegated insurance regulation to the states and the employee retirement income security act of 1974 (erisa) which exempted self-insured large group health insurance plans from state regulation.

[2] group health insurance plans sponsored by employers with 15 or more employees were prohibited by the pregnancy discrimination act of 1978 from excluding maternity coverage for a pre-existing condition of pregnancy; this prohibition was extended to all group health insurance plans by the health insurance portability and accountability act of 1996 (hipaa). [17][20][21] the rationale behind pre-existing condition clauses, according to those who defend the policies, is that they reduce the cost of health insurance coverage for those who still receive it, thus giving more people an opportunity to afford insurance in the first place. [27] the public’s most unanimous and bipartisan support is saved for a proposal to have the federal government require that health insurance companies cover anyone who applies, even if he/she has a pre-existing condition.

in the context of healthcare in the united states, a pre-existing condition is a medical condition that started before a person’s health insurance went into effect. before 2014, some insurance policies would not cover expenses due to pre-existing conditions. pre-existing conditions health insurance companies cannot refuse coverage or charge you more just because you have a “pre-existing condition” — that is, a pre-existing condition a health problem, like asthma, diabetes, or cancer, you had before the date that new health coverage starts. insurance companies can’t all marketplace plans must cover treatment for pre-existing medical conditions. no insurance plan can reject you, charge you more, or refuse to pay for, .

as defined most simply, a pre-existing condition is any health condition that a person has prior to enrolling in health coverage. a pre-existing condition could be known to the person u2013 for example, if she knows she is pregnant already. a medical illness or injury that you have before you start a new health care plan may be considered a “pre-existing condition.” conditions like diabetes a “pre-existing condition” is a health condition that exists before someone applies for or enrolls in a new health insurance policy. insurers generally define a pre-existing condition is a medical condition that is excluded from coverage by an insurance company because the condition was believed to exist prior to, .

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