You're probably NOT required to get her the coverage, but to pay the premiums. You also have a problem with HIPAA Privacy in that she doesn't have to tell you what her medical problems are, nor can you sign the application for her. You may be able to get coverage, without any problems. Then you just have to worry about how long the waiting period is. If she had prior coverage in the last 63 days that coverage applies to the new waiting period.
In certain situations, yes. Medical coverage is not a guarantee, and insurers can eliminate applicants due to pre-existing conditions.
Any medical condition can be a pre-existing condition to an insurance company precluding coverage. However, it is possible to still get coverage and deny the pre-existing clause by providing a certificate of continuous coverage from another insurance company.
What are pre-existing conditions and how do they impact coverage? A pre-existing condition is a health condition (other than a pregnancy) or medical problem that was diagnosed or treated during a specified timeframe prior to enrollment in a new health plan. Some pre-existing conditions may be excluded from coverage during a specified timeframe after the effective date of coverage in a new health plan. Plan documents will provide specific information on pre-existing conditions.The Health Insurance Portability and Accountability Act of 1996 (HIPAA) helps to protect millions of Americans and their families who have pre-existing medical conditions or who might suffer discrimination in health coverage based on factors relating to their health.http://www.aetna.com/members/faq_healthplan.html#12
A pre-existing condition any medical condition that your have been diagnosed with, prior to the time of application. Some pre-existing conditions can cause an applicant to be declined coverage. Other conditions may cause the insurance company to place a "rider" on the condition, meaning they would not cover the condition itslef but will still offer coverage to you.
No, most states require that pre-existing conditions be waived when moving from a group policy to a group policy. Pre-existing condition clauses apply when the break in coverage is greater than 63 days.
Medical Insurance policies will typically deal with pre-existing conditions in one of three ways: # Exclude the pre-existing condition from coverage, but offer other benefits as usual. # Place a 24 month moratorium (or waiting period) on the coverage of the condition. If the policyholder receives no treatment during the moratorium, the condition may be reconsidered for coverage. # Cover the condition by increasing the plan premium. This may not be applicable for all pre-existing conditions. # Cover the condition under a Medical History Disregarded benefit (MHD), which is typically only available to group coverage where 20 or more members are enrolled. There are no industry wide standards for dealing with pre-existing conditions, and each insurance company will provide coverage, or not, in their own way.
major medical coverage
Check the definition in YOUR policy. West's Ann.Cal.Ins.Code ? 10700 q) "Preexisting condition provision" means a policy provision that excludes coverage for charges or expenses incurred during a specified period following the insured's effective date of coverage, as to a condition for which medical advice, diagnosis, care, or treatment was recommended or received during a specified period immediately preceding the effective date of coverage. The important thing is to list it on the application, if and where asked -
The amount and type of insurance coverage should be determined by your age and existing or future medical condition. Insurers are rated by the company called Bests Rating Service.
"Preexisting" : a condition or state which preceded another. (sometimes appears hyphenated as 'pre-existing') A "preexisting condition" : A status for medical afflictions that were already affecting a patient before the beginning of the current (or future) medical coverage or treatment.
Medically underwritten coverage requires a questionaire, in which case pre-existing conditions may not be covered. Guaranteed issue is like an "existing medical condition blind" policy. It may have less coverage, and cost more, because the insurer is taking a bigger chance on the individual applicant.
== == Yes. Check the policy definition. Here's the def. for Small Groups in CA (q) "Preexisting condition provision" means a policy provision that excludes coverage for charges or expenses incurred during a specified period following the insured's effective date of coverage, as to a condition for which medical advice, diagnosis, care, or treatment was recommended or received during a specified period immediately preceding the effective date of coverage. 10708. (a) Preexisting condition provisions of health benefit plans shall not exclude coverage for a period beyond six months following the individual's effective date of coverage and may only relate to conditions for which medical advice, diagnosis, care, or treatment, including the use of prescription medications, was recommended by or received from a licensed health practitioner during the six months immediately preceding the effective date of coverage. (c) In determining whether a preexisting condition provision or a waiting period applies to any person, a plan shall credit the time the person was covered under creditable coverage,
The simple answer is YES. If you are currently pregnant or the expected father you have a pre-existing condition according to health insurance companies. If you are currently pregnant and do not have medical coverage. You should check into a state program to help you.
No, since you have credible coverage. CA Small Group Employer Law - AB 1672 http://www.steveshorr.com/ic_10700_carrier_requirements.htm#10708.%20%20(a)%20Preexisting%20condition Federal Law A limitation or exclusion of benefits for a condition based on the fact that you had the condition before your enrollment date in the group health plan. A pre-existing condition exclusion may be applied to your condition only if the condition is one for which medical advice, diagnosis, care or treatment was recommended or received within the 6 months before your enrollment date in the plan. A pre-existing condition exclusion cannot be applied to pregnancy (regardless of whether the woman had previous coverage), or to genetic information in the absence of a diagnosis. A pre-existing condition exclusion also cannot be applied to a newborn or a child who is adopted or placed for adoption if the child has health coverage within 30 days of birth, adoption or placement for adoption and does not later have a significant break in coverage. If a plan provides coverage to you through an HMO that has an affiliation period, the plan cannot apply a pre-existing condition exclusion. A pre-existing condition exclusion can not be longer than 12 months from your enrollment date (18 months for a late enrollee). A pre-existing condition exclusion that is applied to you must be reduced by the prior creditable coverage you have that was not interrupted by a significant break in coverage. You may show creditable coverage through a certificate of creditable coverage given to you by your prior plan or insurer (including an HMO) or by other proof. The plan can apply a pre-existing condition exclusion to you only if it has first given you written notice. If your plan has both a waiting period and a pre-existing condition exclusion, the exclusion begins when the waiting period begins. In some states, if plan coverage is provided through an insurance policy or HMO, you may have more protections with respect to pre-existing condition exclusions. http://www.dol.gov/elaws/ebsa/health/4.asp
is pregnancy considered a pre-exsisting condition for medical coverage
A pre-existing condition is a medical condition that a person received within 12 months of applying for Health Insurance.For more info click on the link below.
AnswerI would think so, however be sure to check the definition in your policyCA Insurance Code ï¿½ 10700 q) "Preexisting condition provision" means a policy provision that excludes coverage for charges or expenses incurred during a specified period following the insured's effective date of coverage, as to a condition for which medical advice, diagnosis, care, or treatment was recommended or received during a specified period immediately preceding the effective date of coverage.Is the scar removal cosemetic or a medical necessity?What was put down on the application?AnswerScar removal is generally covered under cosmetic and since it sounds like you didn't have treatment during the lookback you should be fine.
Yes, in most states pregnancy is considered a pre-existing medical condition, and applicants for individual or family health insurance can be declined coverage if they're currently pregnant. In addition, some states allow health insurance companies to include clauses in newly issued policies that prevent them from being liable for any costs resulting from a pregnancy that occurs within the first year of coverage.
Any medical condition that happens prior to you applying for the medical insurance is going to be considered a pre-existing condition. If you're applying for individual insurance, most likely the condition will not be covered but possibly medication for the condition would be covered. If you're applying for group insurance, you can check with the benefits administrator at your job to see how pre-existing conditions are covered in the policy, reason being because individual and group policies differ in coverage.
Group Coverage must cover you immediately. They can exclude the Pre-X for 6 months.... There is a provision that if you had prior coverage, that that counts towards the pre-x. I've not found anything in the code that specifically says the prior coverage must be a US Carrier for someone in the US. For more details see http://www.steveshorr.com/technical_questions.htm#What%20is%20a%20Pre-Existing%20Condition
Yes, as are most chronic medical conditions.
No, provided there has been no treatment or care or symptoms during the look back period. In order for it to be considered a pre-existing medical condition it must fit the specific definition found in the policy and usually that requires care, treatment, or symptoms during the look back period to be considered pre-existing. If it occurs outside that period than it's not a pre-existing condition.
Depends on the condition. If your condition raises your risk of premature death (e.g. diabetes), your rates will reflect that.
Maybe but not always. You need to review the definition of pre-existing conditions. Here are two actual definitions: (a) A condition that would have caused an ordinary prudent person to seek medical advice, diagnosis, care or treatment during the twelve (12) months immediately preceding the effective date of coverage; (b) A condition for which medical advice, diagnosis, care or treatment was recommended or received during the twelve (12) months immediately preceding the effective date of coverage; The key here is the timing issue. If two years ago you were diagnosed and were told you needed no treatment and did not need to see the doctor in the previous 12 months then it would not qualify as a pre-ex under these definitions. Remember though, it is not your word that is important; it is what your medical records say. If your doctor advised you have it checked every year, even though it may have been 18 months since you sought any treatment, it would still apply (see the wording of the first definition ��A condition that would have caused an ordinary prudent person to seek medical advice��). The recommendation to have it checked annually would generally meet the standard for a prudent person to seek medical attention.