| Can Group Health Schemes Limit My Coverage Because of A Pre-Existing Medical Condition? |
When it comes to group health insurance schemes there is generally confusion because, while a lot of people argue that group health insurance plans are not permitted to refuse you cover because of your present health or your prior medical history, others contend that they can in fact refuse cover for pre-existing medical conditions.
The truth is that you may not be denied membership of a group health insurance plan solely because of you present medical state, which includes any disability, or as a result of your past medical history.
But, both employers and insurers are allowed to ask you if you have any pre-existing medical conditions when you join a plan or, if you make a claim in the first year of cover, to look back to establish whether you have any prior history of the condition which gives rise to the claim.
Whenever a pre-existing condition is either reported or discovered the insurance company or employer may not simply refuse you cover but is allowed to require an exclusion period for cover of that specific pre-existing condition. Having said this, there are both federal and state laws which govern the exclusions which employers and insurers are permitted to place on their group health schemes.
Group health insurance schemes are not allowed to apply pre-existing condition exclusions as a result of either genetic information or for pregnancy. Additionally, exclusion periods are not permitted for newborns, newly adopted children and children placed for adoption.
Generally speaking, pre-existing condition exclusion periods are only permitted for conditions which are diagnosed within the 6 months prior to joining a group health scheme and for which you have received (or been recommended to have) treatment. This 6 month period is usually called the 'look back' period.
Whenever a pre-existing condition exclusion period is imposed it may not normally exceed 12 months and you have to be credited for any previous continuous creditable coverage. Here cover is considered to be continuous when it has not been interrupted by a break of more than 63 consecutive days. Most private and government sponsored health coverage is considered to be creditable and this will include such things as Medicare, individual health insurance, military health coverage, Indian health insurance, Medicaid, VA coverage, student health insurance, foreign national coverage and much more.
Where an employer imposes a waiting period for people to enter a plan, or an HMO imposes a similar affiliation period, these may not be counted in calculating any break in continuous coverage. Further, any pre-existing condition exclusion period has to take into account the waiting or affiliation period with the exclusion period starting on the same day as the waiting or affiliation period.
If you are moving between group schemes then the administrator of your new plan is allowed to examine your old plan to work out any credit towards a pre-existing condition exclusion period for your new plan. This might mean for example that if your new plan offers cover which was not provided under your old plan then exclusion periods can be imposed for pre-existing conditions which were not previously covered but which are covered under your new plan.
One more point worth noting is that you have to be given appropriate notice of any exclusion period in writing and the group plan administrator has to help you to obtain a certificate of creditable coverage for your former plan if you want him to do so.
 www.MedicalHealthInsuranceToday.com provides information on everything from low cost group health insurance to international long stay travel health insurance
Article Source: UnArchived Articles
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