Can I be denied health insurance if I have a pre-existing condition?
If you are enrolled in a plan since 2010, then your insurer can’t legally deny you coverage or charge you higher premiums because you have a pre-existing condition.
The Affordable Care Act, passed in 2010, made it illegal for insurers to deny you coverage or charge high rates for pre-existing conditions. Additionally, if your health changes and you develop a chronic medical condition while enrolled in a health plan, your insurance carrier cannot raise your rates because of that medical condition. However, annual premium increases may apply to your plan for other reasons.
If, however, you are enrolled in a plan that started before 2010, you have a “grandfathered plan”. These plans can cancel your coverage or can charge you higher rates due to a pre-existing condition.
If you are exploring coverage options, it’s important to be aware of any potential changes to health care law that could impact how pre-existing conditions are covered.
Is pregnancy considered a pre-existing condition?
If you get pregnant before enrolling in a health plan, you cannot be denied coverage or charged more due to pregnancy. Coverage for pregnancy and delivery begins from the day you enroll in a plan.
Is there health insurance for pre-existing conditions?
Choosing a health plan is no longer based on the concept of a pre-existing condition. A health insurer cannot deny you coverage or raise rates for plans if you have a medical condition at the time of enrollment. However, there may be health plans that are a better fit for you than others if you have a chronic, or pre-existing, medical condition.
For example, if you need regular medical care, surgeries, or treatments, then a plan with a little higher monthly premium and lower deductible may provide you with the coverage you need and help you manage more predictable costs.
Could my health plan have a pre-existing condition waiting period?
No. There are no waiting periods for medical plans, including for pre-existing conditions.
When choosing a health plan, consider your medical needs. If you have a chronic or ongoing medical condition that requires more frequent care, those needs could affect the type of plan you choose, but you cannot be denied coverage or charged more due to a pre-existing condition.
A pre-existing condition is a term used by insurance companies to describe a medical condition that existed prior to your disability insurance coverage. If you started a job but cannot continue to work due to a medical condition or symptoms, your insurance company may argue that your condition existed prior to your coverage and may attempt to deny your claim.
How will a pre-existing condition impact my application for Long Term Disability benefits?
Whether you have had a medical problem since youwere a teenager or a more recent condition has developed, being involved in a long-term disability claim with a pre-existing condition can have an impact on your claim.
- Most group long-term disability policies have a pre-existingexclusion that will disqualify entitlement for individuals who submit a disability claim for a condition that arose in the period prior to them being covered under their employer's group benefit plan.
- If you have only had disability coverage for a short amount of time (ie: less than one year), then any claim would usually be reviewed to determine whether it can be denied based on the exclusion clause for pre-existing conditions, which is part of most long-term disability polices.
- The wording of your insurance policy is crucial and can be lengthy. Any insurance policy should be carefully reviewed to determine specific provisions and how they may apply. This should be done by an experienced lawyer.
Will it matter if I have a pre-existing medical condition?
A pre-existing condition will only matter if the claim occurs within the period during the pre-existing exclusion clause applies, so, in most cases, if the disability arises more than one year from when coverage was put into place, the pre-existing exclusion will not apply. The policy wording must be checked to determine the specific clause in each case.
What is a pre-existing exclusion clause?
A pre-existing exclusion clause exists to try to make sure that someone who has a long-standing history of medical problems and has only recently joined a group benefit program should not get coverage for disability benefits.
- The insurance company can only raise the pre-existing exclusion clause in applicable circumstances.
Watch Our Video:
Find out what David Share, President of Share Lawyers and Adjunct Professor at Osgoode Hall Law School, has to say about a disability claim denied based on pre-existing exclusion and what can be done about it.
Changing Jobs – How can I avoid the pre-existing clause?
- Changing your place of employment usually means that you will be subject to whatever pre-existing exclusion clause applies to the group benefits at the new employer.
- If you have been struggling with your health and are dealing with a condition or an illness, even though you are able to work, you should take into consideration the potential impact of changing employers should a disability occur within the initial period.
- In some cases, you might be able to get your employer to request that the pre-existing exclusion be waived, however, that would require a prospective employee to advise his new employer that he or she is struggling with a chronic illness, which could pose a barrier in the hiring process, so it may not be realistic to broach this subject with a prospective employer. Bottom line is that while one cannot necessarily anticipate and plan for every single contingency, at least be aware of this issue if and when you consider making a career move.
How can I overcome a pre-existing exclusion?
You may be able to overcome a denial from an insurance company if the medical condition that you were suffering from before is different from the medical condition that you are suffering from now. We may be able to argue that the new condition is quite different and distinct from the pre-existing condition that you were suffering with in the past. At Share Lawyers, we review cases that have been denied based on a pre-existing exclusion and in some cases, it is possible to avoid the applicability of the exclusion clause, but this is an added challenge to a disability case, which can be insurmountable in some situations. If you’re unsure about how this may apply to you, it should be reviewed by an experienced disability lawyer at Share Lawyers who can assess the chances of success.