Insurance existing condition is a clause in the insurance policy that states a members claim will not be covered or it can be denied for any medical illness, diagnoses and treatment before the new insurance effective date. The pre-existing condition is any medical condition that was diagnosed and treated within a specific time before the new insurance effective date or new insurance was obtained. An insurance company can cancel or deny a claim if the policy holder failed to inform them of a pre-existing condition.

The language on the pre-existing clause varies from policy to policy. It use to be that if an employee left one employer for another they would need to wait a certain period before they can be covered and/or if they had a medical condition that was diagnosed and treated before the new insurance, they would probably not have been covered. A careful review of the denied claim can determine if there was an error in the coding of the claim by the medical office, or if the condition was indeed pre-existing. The Health Insurance Portability Accountability Act 1996, (HIPAA) was designed to allow an employee to move from one employer to the other without risk of not being covered.

HIPAA also protects individuals who change from group plans to an individual health plan. Depending on some states, some group coverage may make the employee wait 12 months for pre-existing condition after enrollment and 18 months if the enrollment period was missed. If the new employer provided insurance does not have a preexisting condition clause, it can still require a “waiting period” of up to 6 months before the employee insurance coverage is effective. You can not be denied health insurance coverage if you had continuous insurance coverage with out break, under the Consolidated Omnibus Budget Reconciliation Act COBRA continuation coverage. There are insurance companies out there that provide coverage for individuals with serious health problems, as well as individual state funded insurance.

Insurance existing medical conditions are not always easy to obtain but they are out there. Some pre-existing insurance will have you wait of twelve month coverage before your pre-existing condition can be covered.

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