Pre-existing Condition Laws
Pre-existing condition laws detail the legal provisions regarding the coverage of pre-existing conditions by health insurance providers. Both the federal and state systems have enacted pre-existing condition laws that aim to protect policyholders. Many insurers regard individuals with pre-existing medical conditions as greater liabilities and will often deny coverage completely or refuse to cover the existing condition.
The definition of a pre-existing condition may vary from policy to policy, and therefore it is beneficial for insured individuals to become familiar with the specific terms of their policy. In general, a pre-existing condition is defined as any medical condition that a person had knowledge of, or had been treated for, prior to enrolling in a health insurance program. Under pre-existing condition laws, an existing condition is one for which medical devise, diagnosis, care, or treatment was recommended or received within the six months prior to the health insurance enrollment date. This period of time is known as the "look back" period under pre-existing condition laws. The look back period may be smaller for bigger company insurance policies, as determined by pre-existing condition laws.
The most comprehensive of all the pre-existing condition laws, is a federal law that was passed in July of 1997. The HIPAA, or Health Insurance Portability and Accountability Act , limits the amount of time and specific circumstances under which coverage for pre-existing condition coverage and be lawfully denied to a beneficiary. Under most pre-existing condition laws, coverage for a per-existing condition can be denied for a maximum period of twelve months (eighteen for late enrollees).
Federal pre-existing condition laws help protect consumer's health benefits by limiting exclusion periods, lowering the chances of losing existing coverage, providing protection when an insured changes jobs, and a number of other benefits. There are also certain medical conditions that cannot be denied coverage under pre-existing condition laws, including pregnancy, children under 18 who have been adopted, and the like.
In addition to protecting the rights of policyholders with pre-existing conditions, the HIPAA also protects the privacy of health care patients, and much more. Failure to comply with HIPAA pre-existing condition laws and provisions can result in civil and criminal penalties.
In addition to the federal HIPAA, each state has pre-existing condition laws which regulate the insurance industry, protect consumer rights, and provide a method of legal action for those who have suffered damages because of pre-existing condition laws violations. If you have been wrongly denied health care coverage because of a pre-existing medical condition, you may wish to contact an experienced and qualified attorney who can evaluate your case to determine your legal rights and options.
Please contact us to speak with an attorney about pre-existing condition laws and how best to protect and maximize your legal interests.
