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Why does having health insurance before being diagnosed with a serious condition make a difference?

How do insurance companies handle a pre-existing conditions when the condition was diagnosed while insured?

  • My fiance recently lost the insurance granted to her under her fathers work health plan. She turned 22 and the plan stops covering dependents when they reach that age. She was diagnosed with a pre-existing stomach condition (nothing too serious) that requires a few perscriptions every month. Since she is still in school (even when she graduates she probably won't be offered insurance through her job - she's in theater) she doesn't have insurance through a corporate policy. She will need to get private insurance. Will she be able to find a private insurance company? Or will her pre-existing condition hinder her chances? Is the previous insurer responsible for continuing costs of the condition diagnosed while under their protection?

  • Answer:

    The previous company will not be responsible for continuing costs even if she gets on a plan with the same company. It will be considered pre-existing. What the insurance company will do will depend upon the severity of the condition and the cost of the medication (you may think it's not too serious but the insurance company may think otherwise). They may impose a waiting period of 6 to 12 months depending on your state laws. If the condition is not too costly or too serious they may actually waive the waiting period if she gets coverage immediately after loosing her current coverage. If the condition is costly or serious they may exclude coverage for that condition, increase the premium, or deny to cover her at all. Each insurance company has different requirements so just because one company does one thing that doesn't mean they all will. She'll need to visit a local agent that works with all the major companies in your area. The agent can find out what each company may do in her case and can find the best plan for her. There is no extra charge using an agent.

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No, the previous insurer is not "responsible" once she is no longer insured under it. She will have to obtain an individual plan and should consult a broker who handles such plans.

rotflol

The previous insurer is NOT on the hook for costs of this condition. Depending on what the condition is, a new insurer may choose to exclude coverage for it, if she's lucky, or may flat out refuse to take her on at all. She should check with her school, see if she can sign on to their group policy.

mbrcatz

The school's group insurance is probably the most affordable, but you could check what coverage is available under COBRA. The company insurance plan is probably better coverage than the school. Coverage under COBRA is usually ~5% over the premium that the employer paid, but you get the plan you are on now. Theater majors usually work at day jobs until they get established -- consider employers such as Starbucks, Jack-in-the-Box or even Wall Mart if you can be part of their group plan. When you are a new employee and become eligible for benefits, they can not ask about pre-existing conditions.

Christi T

1) it IS true that a prospective employer cannot ask her about pre existing conditions. it is NOT true that an insurance company cannot ask her. the insurance company can underwrite whoever and whatever they want within legal means. 2) most companies offer non-underwritten plans.. they are very expensive and most times to be eligible, you have to exhaust COBRA. 3) just because she has that condition does not mean she will not be covered. most companies use a rating system. she may be accepted at a higher rate, you never know til you try. go online to the major companies and apply. if the rate is too high, you can cancel the policy immediately

Angee

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