Individuals may be denied coverage due to pre-existing conditions.
Pre-existing conditions are health issues that occur prior to enrollment in a new health insurance plan. While federal laws protect your rights in some circumstances, pre-existing conditions may result in denied or delayed coverage. State and federal programs are available for uninsured or underinsured individuals denied health insurance based on a previous condition. Coverage and requirements may depend on your age, income and disability factors.
HIPAA Laws
Under the Health Insurance Portability and Accountability Act, you qualify for employer group health insurance for a pre-existing condition if you were not diagnosed, treated for or offered medical advice for the condition within six months prior to enrollment. If your condition qualifies for pre-existing exclusions under an employer health plan, the insurance company may exclude care for 12 to 18 months depending on your enrollment date. The exclusion only applies to coverage for the pre-existing condition, not other health care benefits under the plan.
PCIP Coverage
As of 2010, the federally mandated Pre-Existing Condition Insurance Plan offers health insurance to individuals denied coverage based on their condition. Eligible candidates must be uninsured for six months and must be U.S. citizens or legal aliens. The plan provides primary care, specialty services, hospitalization and prescription assistance. Premium payments and deductibles apply based on local health care costs. Apply for coverage at your state Social Services Office or equivalent or call the U.S. Department of Health and Human Services at 1-866-717-5826 for more information.
Medicaid
Medicaid offers full health care coverage to qualifying low-income residents. Individual states determine eligibility and benefits based on income, assets and household size. While many low-income families qualify for free coverage, premiums and co-pays may apply depending on state laws. Medicaid provides retroactive coverage up to three months if the applicant would have qualified for coverage during that period. Additionally, Medicaid allows dual coverage with other insurance plans.
Medicare
Medicare provides health insurance to adults age 65 or older, individuals with disabilities and people with kidney diseases requiring dialysis or kidney transplants. Applicants may qualify for Medicare Part A --- hospital insurance --- or Medicare Part B for most other services based on individual or spousal work histories. Individuals ineligible for Medicare based on work may pay a monthly premium to enroll.
CHIP for Children
The federally governed and state administered Children's Health Insurance Program offers coverage to qualifying uninsured children ineligible for Medicaid. The plan provides free or low-cost health care based on your income. States determine eligibility and benefits based on federal guidelines. Contact your local Department of Social Services regarding eligibility and application information.
Tags: health care, health insurance, benefits based, coverage pre-existing, coverage qualifying, denied coverage
