What is a Pre-existing Condition Exclusionary Period?

If you have a pre-existing condition such as asthma, heart disease, chronic headaches, or high blood pressure, it may affect your health insurance coverage. A pre-existing condition can lead to higher health insurance premiums or restrictions, including an exclusionary period that comes into play when you enroll in a new plan or change jobs.

A pre-existing condition exclusionary period allows an insurance company to provide you with conditional coverage while reducing its liabilities for expenses related to your health condition. Your health plan will generally cover your routine health care needs and any health services that are not directly or indirectly linked to your pre-existing condition. Costs associated with your pre-existing condition will need to be paid out of pocket during the exclusionary period, which can range from six months to 18 months, depending on the individual health insurance policy and the date on which you enrolled in the plan.

For those with serious health conditions, a six to 18 month wait for coverage may seem excessive. However, the pre-exclusionary period may not apply at all if you had what is known as credible coverage prior to enrollment. Credible coverage can apply to any uninterrupted health coverage you had before your new policy began. A certificate of credible coverage can reduce or even eliminate your pre-existing condition exclusionary period. In other cases, your group health insurance plan may only exclude conditions for which you sought treatment in a specific period before you enrolled in the new plan.

The pre-existing condition exclusionary period does not include some conditions. For example, a newborn who is enrolled within 30 days of his or her birth cannot be excluded from coverage for health conditions, and genetic information cannot be used to initiate an exclusionary period if no condition has actually been diagnosed.

Pre-existing conditions do not have to preclude you from obtaining affordable insurance. To learn more about your options, talk to one of our experienced agents today.

Source: Health Care Los Angeles

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