Accidents illnesses can strike unexpectedly people need to secure themselves against financial losses due to such circumstances. Accident health insurance policies are designed to offer financial protection not only for emergencies but also for pre-existing conditions.

A pre-existing condition is any health issue that exists before the policyholder applies for health insurance. According to the Affordable Care Act (ACA) health insurers cannot refuse coverage to policyholders with pre-existing conditions. However insurance companies may apply coverage delays or increased premiums for these individuals.

Health insurance providers offer several provisions that address pre-existing conditions. These provisions vary depending on your health insurance policy state regulations employer policies. The following sections provide an overview of some of the essential provisions for pre-existing conditions.

Elimination of a Pre-Existing Condition Waiting Period

Before the full implementation of the ACA in 2014 insurance carriers could enforce a pre-existing condition waiting period before providing coverage for policyholders. The waiting period could last up to 12 months during which time the policyholder would not benefit from the insurance coverage. Policyholders with pre-existing conditions could appeal to their health plan to waive the waiting period but typically obtaining an exemption was difficult.

The ACA eliminated pre-existing waiting periods meaning that insurance carriers could no longer impose them on new or renewing policyholders. However health plans can still delay coverage for pre-existing conditions for a certain period typically six months. The delay is meant to promote continuous health coverage for people safeguard insurers from covering individuals who seek health coverage when they fall ill.

Continuation Coverage Provision

Employees who terminate their contracts employment or employer-sponsored health coverage may lose their insurance coverage. COBRA(Consolidated Omnibus Budget Reconciliation Act) is a federal law that allows employees their families to maintain their health coverage temporarily. This provision applies to organizations with more than 20 employees.

COBRA continuation coverage may last up to 18 months or 36 months for individuals who are eligible for disability benefits. Policyholders can qualify for the continuous coverage benefit if they have a pre-existing condition but the benefits will be subject to the waiting period of delayed coverage.

Guaranteed Issue Provision

Under guaranteed issue provisions insurers cannot deny coverage to policyholders due to pre-existing conditions. In other words people with pre-existing conditions can still apply for health insurance coverage. Guaranteed issue provisions apply to non-group health insurance policies (known as individual or family plans) small group health insurance coverage for organizations with fewer than 50 employees.

Guaranteed issue provisions are somewhat risky for insurance carriers. Insurers can experience significant losses if unprofitable policyholders sign up for coverage. To counter this insurance companies may set limits like precise enrollment periods that apply only to specific dates or keep coverage only to specific insurance products.

Conclusion

It’s essential to research understthe provisions that apply to your health insurance policies ensuring you your loved ones get the care financial support you need. Pre-existing condition provisions will differ according to the type of policy you have the state you reside in the organization you work for. Understanding these provisions can help you access the necessary medical financial assistance when you need it regardless of any pre-existing conditions.