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I thought the laws had changed and if you did not have health insurance before but became eligible through a company group plan, that pre-existing conditions had to be covered? Is that correct or do I have the terms of this changed?
Asked on May 13, 2009 under Insurance Law, Arizona
Answered 15 years ago | Contributor
It depends on your state and type of coverage. Here is the main website for the Arizona Dept of Insurance covering health insurance issues:
http://www.id.state.az.us/consumerlifehealth.html
This is the hyperlink to the Group Health Care handbook: http://www.id.state.az.us/publications/Health_Group.pdf
A portion of the handbook discusses pre-existing conditions and this is what it says:
"III.
III.
These provisions limit or exclude the insurance company’sobligation to pay benefits.
These provisions limit or exclude the insurance company’s
obligation to pay benefits.
Policies have a list of exclusionsand limitations.
and limitations.
Policies with fewer exclusions may be moreexpensive than policies with more exclusions. Make sure youunderstand what will and will not be covered.
expensive than policies with more exclusions. Make sure you
understand what will and will not be covered.
·
Waiting PeriodsA waiting period is the amount of time that must pass afterthe policy takes effect and before coverage begins. If a policyhas a waiting period, benefits will not be paid or they mightbe limited for expenses that arise during a specific number ofdays after the policy is in effect. Waiting periods are notapplicable in some cases if an individual had certain types ofprior coverage. Waiting periods may apply only to certainconditions or services. ·
A waiting period is the amount of time that must pass after
the policy takes effect and before coverage begins. If a policy
has a waiting period, benefits will not be paid or they might
be limited for expenses that arise during a specific number of
days after the policy is in effect. Waiting periods are not
applicable in some cases if an individual had certain types of
prior coverage. Waiting periods may apply only to certain
conditions or services.
Preexisting ConditionsIndividual policies usually will not pay benefits until a certaintime period has elapsed for a health condition you had whenyou bought the policy. This type of health condition is knownas a “preexisting” condition. Exclusions for preexistingconditions are intended to preclude individuals with an illnessor injury from waiting to buy a policy until they need treatmentthat would otherwise be paid for under the policy.You should know the meaning of any provisionsexcluding benefits for preexisting conditions. Also, youshould know how long the provision will exclude benefitsfor preexisting conditions. Many claims are deniedbecause of these provisions.Waiting Periods, Preexisting Conditions,Exclusions and Limitations8If you are covered by a group policy provided by youremployer, the waiting period for preexisting conditions cannotbe any longer than 12 months. It may be less or notapplicable at all if you have had previous group coverage.Do not think that because the application asks no questionsabout your health or medical history or the policy requires nophysical examination, the policy will cover conditions that youalready have. It probably will not. If the company asksquestions about your health history it is important to answerthem truthfully.Under some definitions a condition would be considered“preexisting” even if you did not know that you had thecondition before you bought your policy. Also, you need toknow how many previous years will be considered fordetermining a preexisting condition. A group health planprovided through your employer cannot look back any furtherthan six months before your effective date.·
Individual policies usually will not pay benefits until a certain
time period has elapsed for a health condition you had when
you bought the policy. This type of health condition is known
as a “preexisting” condition. Exclusions for preexisting
conditions are intended to preclude individuals with an illness
or injury from waiting to buy a policy until they need treatment
that would otherwise be paid for under the policy.
You should know the meaning of any provisions
excluding benefits for preexisting conditions. Also, you
should know how long the provision will exclude benefits
for preexisting conditions. Many claims are denied
because of these provisions.
Waiting Periods, Preexisting Conditions,
Exclusions and Limitations
8
If you are covered by a group policy provided by your
employer, the waiting period for preexisting conditions cannot
be any longer than 12 months. It may be less or not
applicable at all if you have had previous group coverage.
Do not think that because the application asks no questions
about your health or medical history or the policy requires no
physical examination, the policy will cover conditions that you
already have. It probably will not. If the company asks
questions about your health history it is important to answer
them truthfully.
Under some definitions a condition would be considered
“preexisting” even if you did not know that you had the
condition before you bought your policy. Also, you need to
know how many previous years will be considered for
determining a preexisting condition. A group health plan
provided through your employer cannot look back any further
than six months before your effective date.
Other ExclusionsIn addition to preexisting conditions, health insurance policiesusually exclude illness or injury resulting from war or militaryservice or those covered under workers’ compensation."
In addition to preexisting conditions, health insurance policies
usually exclude illness or injury resulting from war or military
service or those covered under workers’ compensation."
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