Is pregnancy considered a preexisting condition if the person purchased insurance after they were pregnant but did not know they were pregnant?
Yes it is, still pre-existing, even if it wasnt to your knowledge. Answer HIPAA is the law. Best chances for HIPAA to apply are if you go from a group plan to a group plan. Evidentally, individual to group and nothing to group are loop holes, so they can probably get out of it, or make you wait a certain amount of time. Answer According to a Federal law that I found on the internet, GROUP health insurance cannot consider pregnancy a pre-existing condition if they currently have maternity coverage. However, this law does not apply to INDIVIDUAL health insurance. So, if you've changed jobs, and you now have a GROUP health insurance plan, then there is a good chance that you may be covered. I just recently got individual insurance through BCBS and I was pregnant and did not know when I requested maternity coverage. BCBS policy says that pregnancy can not be considered a pre-existing condition and their definition of a pre-exisiting condition is a condition that you can been receiving treatment and/or professional advice and help for for 6 months or more before opting for coverage. Also, they say that except for pregnancy all pre-exisiting conditions require a 180 day waiting period.
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A pre-existing condition is a medical condition that existed beforeyou obtained health insurance. It is significant because theinsurer may not cover the pre-existing condition… for the durationof the pre-existing condition period. The policy will provide for astated time period within which it will not provide benefits forthe condition. The pre-existing condition exclusion period varies by insurancecompany, and also by the State in which the policy is issued.Currently, State law regulates the terms and conditions ofinsurance policies. For example, some States have disallowedcertain types of provisions, including mcertain medical conditionsto which they might otherwise apply. All of that may change if there occurs greater Federal involvementin the regulation of health insurance, but the odds are that newlaws will apply only upon the expiration of existing insurancecontracts and for the issuance of new contracts after such laws areimplemented. The rationale for pre-existing condition exclusions is that medicalinsurance works the same way other insurances do: that insurancecovers fortuitous occurrences, nor ones that are planned,intentional, or predictable. Stated otherwise, you need to havecoverage in place before something adverse happens. An analogy isthat just like you can't buy auto insurance after an accident tocover the cost of the accident, medical insurance only coversissues that arise unexpectedly after coverage has begun. Pre-existing conditions are usually chronic and often costlyconditions such as: . diabetes . heart problems . mental illness . asthma . COPD . Hemophilia . Epilepsy . Chronic Infections . a pregnancy prior to coverage . an injury which occurred prior to coverage. . multiple sclerosis, etc. . certain allergies . certain skin conditions If you think you may have a condition that might be pre-existingyou can ask the insurance company if there are exceptions and ifyour physician can confirm you have not suffered or been treatedfor the problem during the time period designated by the insurancecompany. Some companies may decide they cannot cover you if you areseeking individual coverage (rather than group coverage).
No. According to the Department of Labor' HIPAA Act of 1996, "... HIPAA prohibits plans from applying a preexisting condition exclusion to pregnancy, genetic information, a…nd certain children". Info from Dept. of Labor website: www.dol.gov/ebsa/faqs/faq_consumer_hipaa.HTML yes. the laws that govern group and individual health plans are a little different when it comes to pre-existing conditions, and are enforced or regulated by the state department of insurance in the state where you live. individual plans, almost without exception, will not take on a pregnant applicant, or even a male who is looking for a health plan if he's fathered a child that hasn't been born yet. group plans are much more likely to accept a pregnant employee, or the spouse of a pregnant woman, on their plan after the employer's probation period is over. however, it's possible if the pregnancy is beyond the first trimester to encounter problems getting accepted. the fastest way to get the true in this situation is to find out what the employer's probation period is (90 days or whatever), and also ask the benefits administrator at the company to call the health insurance carrier and ask them directly. in Texas, by law, pregnancy is supposed to be covered like any other pre-existing condition on a group plan. however, if pre-ex conditions have a waiting period of 12 months and baby is due in 6 months, it doesn't help a new employee much. finally, every state has an individual health insurance plan that is sponsored by the state department, for persons with pre-existing that can't get covered or accepted anywhere. do a Google search for "[your state] department of insurance" and the link for the site will come up. contact them or review the website and look for the 'risk pool' plan. in Texas, blue cross blue shield is the provider. every state is difference. this individual policy provides coverage for persons with terminal illness, pregnancy, and anything else other insurance companies often decline or charge a fortune to cover. the premiums are about 1.25 - 1.5 times more than health insurance for the same applicant would be with a company that does not cover pre-existing conditions, but the coverage is guaranteed. in other words, you can't be declined. this works perfectly if you already have health insurance that doesn't cover maternity. the risk pool plan will have at least a 12 month waiting period for pre-ex, like group health plans do. if you have had your old health insurance for any period of time - especially for twelve months already - you get credit for that coverage and your waiting period for pre-ex is eliminated on the new plan. if you had coverage for six months, the risk pool would give you six months of credit off the pre-ex waiting period. if your baby's due in 8 months, it will work because you only have to wait six months for the pre-ex part of the coverage to be effective. if your baby's due in 2 months, your pre-ex period won't be over yet and it the pregnancy won't be covered. so what do you do if the s above don't work for you ...? in a worse case scenario, you can approach your obstetrician and negotiate a price for a package deal of nine months of prenatal care and baby delivery. the cost would be at least $2,500-3,500; for c-sec, $5,000-7,000. your cash offer should be 50% of whatever the doctor charges insurance companies for the same service. offer monthly payments with the last one due on the baby's due date. you can negotiate the hospital bill for a package deal for an overnight stay the same way. call each medical care provider (ob and the hospital) to get the charge they send to insurance companies for the services you need before you let on you need to negotiate your bill. if you can, pay the hospital installments over the nine months during the pregnancy and they'll be more likely to agree to the arrangement. collecting money for medical services after the care has been rendered is really difficult, so many medical providers don't like to negotiate at all. don't be discouraged. good ob docs and hospitals do this everyday, but it's not in the grapevine for the public to know. it's easy to panic if you're expecting and don't have maternity. instill the idea in your mind that everything's negotiable, and trudge ahead with finding a doctor and hospital you like. your determination will show and help you during negotiations. it's also a good persuasion tool to write your arrangement on paper when you present it to a medical care provider to show how serious you are. if you have any other questions, please feel free to email me. I'm a Group One licensed insurance agent. i sell health, life, dental, annuities and am just about to publish a book to explain insurance better for consumers and help them save 3-4 figures a year on health insurance premiums. to the extent i can help any more i'd be glad to. NOT ALWAYS! Some plans may have a pre x clause that includes everything EXCEPT pregnancy. No. According to the HIPAA regulations of 1996, pregnancy can NEVER (no matter what state or what insurance company) be considered a pre-existing condition in group health plans. For reference: http://cms.hhs.gov/hipaa/online/group/family/Pregnancy_content.asp?record=480021 The honest is sometimes. It all depends on whether or not the organization offering insurance has opted for HIPAA regulated insurance. In my own personal account I was denied coverage for my pregnant wife when switching from one group insurance from the private sector to a group insurance in the county government sector. So, you see that it is not always excluded from being pre-existing.
What is considered a preexisting medical condition that will likely cause denial of health insurance?
\n. \n Answer \n. \n. \ncancer or any other terminal disease. not sure about chronic health problems like diabetes or high blood pressure.\n. \n Answer \n. \nFrom… a tactical perspective, any illness that the insurance company has determined will likely cost them more money than they can make on premiums. There are some illnesses that they think are more costly but they can offer coverage profitably if they offer you a higher premium.\n. \nA quick review of 'Declinable Conditions' (those that will result in an automatic decline under all circumstances) from Blue Cross of CA is about 120 items. There are probably another 100 conditions that they may choose to deny coverage depending on severity. \n. \nAs for the answer above, insulin dependent diabetes is almost always a decline, high blood pressure will generally be declined only if it is uncontrolled.
Is pregnancy considered a pre-existing condition if applied for insurance before got pregnant but policy doesn't start until after got pregnant?
Answer . Is this a group or individual plan?. For an individual plan, it probably is - check the policy.
Would finding out your pregnant before your insurance has begun be considered a preexisting situation?
\n. \n Answer \n. \nYes. Check the definition though in your policy.
Is it possible to add a pregnant spouse during the open enroll period for insurance and the pregnancy not be considered preexisting?
If the pregnancy began before the first date of coverage - yes it is preexisting.
Is pregnancy considered a preexisting condition if you move from a group insurance plan with a Mexican insurer to an American small business group insurance plan?
\n. \n Answer \n. \nCA AB 1672 aka Insurance Code 10700 et seq\n. \n- see the term ELSEWHERE below\n. \n(r) "Creditable coverage" means:\n(1) Any individual or group… policy, contract, or program, that is written or administered by a disability insurer, health care service plan, fraternal benefits society, self-insured employer plan, or any other entity, in this state or elsewhere, and that arranges or provides medical, hospital, and surgical coverage not designed to\nsupplement other private or governmental plans.
Most medical conditions that you've been diagnosed with prior to applying for the insurance will be considered pre-existing. If you've been seeing a psychiatrist before or dur…ing the application process, it will be considered pre-existing.
Yes, it is, and so is pregnancy, or herpes......in the USA anyways...
Chlamydia is pre-existing if you were diagnosed with the condition prior to completing the application process. I write applications for BlueCross BlueShield of Florida, and w…ith us, if you have been diagnosed with Chlamydia prior to the application process you will not be eligible for coverage. Other companies/states may vary.
Yes. Many insurance companies will place a waiting period on maternity coverage to ensure that the policyholder is not purely purchasing the policy to take advantage of a mate…rnity benefit. The typical waiting period for a maternity benefit is between 12 and 24 months from the start of the plan. It is important to note, however, that it can be possible to receive a newborn coverage benefit at a much earlier time (in some cases as early as 6 months). If you have your delivery during the policy waiting period for maternity then none of your expenses will be reimbursed by the insurer. It is important that all policyholders understand how long the waiting period is for all benefits on their health insurance plan.
You may be able to find information by doing a search on "Guaranteed Issue" policies in your state.
Medical Insurance policies will typically deal with pre-existing conditions in one of three ways: . Exclude the pre-existing condition from coverage, but offer other benefi…ts as usual. . Place a 24 month moratorium (or waiting period) on the coverage of the condition. If the policyholder receives no treatment during the moratorium, the condition may be reconsidered for coverage. . Cover the condition by increasing the plan premium. This may not be applicable for all pre-existing conditions. . Cover the condition under a Medical History Disregarded benefit (MHD), which is typically only available to group coverage where 20 or more members are enrolled. . There are no industry wide standards for dealing with pre-existing conditions, and each insurance company will provide coverage, or not, in their own way.
According to my insurance company if you have seen a doctor about the condition it is preexisting.
Depending upon the kind of seizures (grand mal, petit mal, etc), its recency, and its frequency, seizures may be considered to be a preexisting condition. A preexisting condit…ion is one that has manifested itself before the application for insurance. Among the medical questions that are asked on the application for insurance may be one pertaining to seizures. The question may be phrased in such a way that the insurer asks about seizures occurring within a stated period of time in the past. If there have been none within that period, the applicant may be able to honestly answer "No". Alternately, the question may be asked as to whether the applicant has "ever" had a seizure. If the applicant has had one or more, the honest answer is "Yes". Even if the applicant has had one or more seizures, and acknowledges it/them on the application, some insurers will issue a policy. In fact, the trend in health insurance is to preclude insurers from denying policies to applicants with preexisting conditions. One of the major problems that sometimes arises is when the applicant is not truthful about health history. Often, that misrepresentation is discovered when the insured submits a claim for benefits. Because insurers investigate the type of claim and the need for the medical service, it is sometimes discovered that the service was connected with a condition that predated the policy. If the insured's misrepresentation was such that had the insurer known about it, it would have either not issued the policy, or would have issued it only for a higher premium, it may have the right to cancel the policy "ab initio". This means that the policy would be canceled retroactively from its inception.