Bonveda's Blog

What is a pre-existing condition?

A pre-existing condition is any injury or sickness for which diagnosis has been made, treatment has been recommended, treatment has been rendered, or expenses have been incurred within a set amount of months prior to the effective date of coverage (usually 3, 6 or 12 months and this can vary by state). It includes any condition manifesting itself in symptoms which would cause a prudent person to seek medical advice.

What is a pre-existing condition exclusion period?

Insurance companies try to discourage people from waiting until they get sick to purchase medical insurance. This is accomplished by imposing what is known as a preexisting condition exclusion period. This simply means, if you have a medical problem which exists at the time you purchase insurance, the insurer will deny the claims pertaining to that medical problem for a certain period of time.

The rules governing preexisting condition exclusion periods in individual health policies vary widely from state to state and are very much different from the rules of an employer-sponsored plan. If you have or recently have had health coverage, you may be able to apply this creditable coverage to offset a preexisting condition exclusion period.

Why all the hoopla over a pre-existing condition?

The biggest stumbling block with private individual medical insurance is the problem with preexisting conditions. Plain and simple... insurance companies don't like preexisting conditions. They know in the long run... it will cost them more money to insure you. Frankly, insurers prefer to insure people who are not very likely to need the insurance.

But stop and think! Who doesn't have some kind of health or medical issue? It may be something as simple as asthma or as complex as cancer. Some pre-existing conditions can be managed and these individuals can live a relatively healthy and normal life.
Yet, insurers can and do turn down "high risks" individuals for coverage because of an existing or previous illness. Even if coverage is found, the premiums charged are often unaffordable. Sometimes the individual may end up with a modified policy paying more because of their medical history or having to take a policy that excludes their pre existing conditions.

Are there things I can do to get healthcare coverage?

Here are some choices for obtaining health coverage. See if any apply to your situation.

(1). Employer-sponsored group health plan

(2). Join a professional organization (e.g. Chamber of Commerce)

(3). Individual health insurance

(4). State risk pool (if one exist in your state)

(5). Discount health cards

(6). Guaranteed Issue Health Insurance

Whether covered by insurance or by some other means, the total cost of health insurance for someone with pre existing conditions is high enough to dramatically impact that person's lifestyle.