The Ugly Reality of Pre-Existing Conditions

One of the biggest problems with obtaining and keeping health insurance is the issue of pre-existing conditions. It is bad enough you or your dependent is sick, but because of that, insurance companies are weary of taking on your coverage. They know that a serious or ongoing health risk will most likely require treatment in the future, which is going to bump up their costs. Therefore, they will avoid these costs if at all possible by carefully evaluating health status and history on insurance applications. There have been measures to protect you in this arena.

The Health Insurance Portability and Accountability Act of ’96 is a federal law that has changed health insurance guidelines in numerous ways, but it puts certain restrictions on providers surrounding the exclusion periods and pre-existing condition rules.

Besides federal regulations, states vary according to specific reforms such as laws on fully insured group health plans and individual health plans. Keep this in mind if you are planning on leaving Nevada, as the rules you are familiar with may not be the same in another.

This is especially important if you are one who deals with a pre-existing condition. Despite all of the liberties that insurance providers do have even with the laws and regulations, there are some boundaries they are unable to cross. Know how you are protected and what your provider is not allowed to do.

In Nevada, coverage under a group plan cannot be denied or limited. If you start a job and are offered benefits including health insurance, you are guaranteed coverage by that group provider. You are also not in jeopardy of the pre-existing condition or health status stipulations. You cannot be rejected for your state of health if you are under a group plan. This law is called nondiscrimination. Remember that group plans offer protections such as these that individual plans may not.

Even though you are more likely to run into pre-existing condition rules with an individual plan, Nevada does put restrictions and limits on those policies. There are rules about what counts as a pre-existing condition, so the health insurance provider is not free to pass subjective judgment. There are also rules about how long you have to wait before the insurance provider must begin to cover the pre-existing condition medical costs.

Usually if you go from a group plan to another, you will still have the old provider’s coverage for some or most of the exclusion period declared by the new provider. This ensures that you will not be without insurance just for changing jobs or losing a job and getting another one. This is a general rule and may only apply if there is a short break in coverage.