Question:

What is a pre-existing condition?

Answer:

A health insurance company will require you to fill out a medical form when you first enroll onto their health insurance plan (in most cases).  If a condition listed on this form existed prior to your enrollment, the health insurance company may request medical records for the past 10 years.  If they determine treatment was sought for that particular condition, the health insurance company can impose a waiting period on that condition.  This means they will not offer pay any claims for up to 12 months on that particular pre-existing condition (including prescriptions and office visits).   There is a Federal law called the Health Insurance Portability and Accountability Act (HIPAA) that helps protect employees moving from one employer to the next.

Under HIPAA, a pre-existing condition will be covered without a waiting period when you join a new group plan if you have been insured the previous 12 months and you did not incur a loss of coverage greater than 63 days. This means that if you had a job with health insurance for 12 months and then move to another job with health insurance, you won’t have a pre-existing condition waiting period as long as you didn’t lose coverage for any reason for a period of 63 days or less.

If you have a pre-existing condition and have not been insured the previous 12 months before joining a new health insurance plan, the new health insurance company may require you to wait up to 12 months before they will pay any claims on that specific condition (including prescriptions and office visits). 

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