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8. What if you have a pre-existing condition?
Before passage of the Health Insurance Portability and Accountability
Act (HIPAA) in 1997, people had to worry about health insurance
coverage for preexisting conditions like diabetes, heart disease,
or cancer. If you changed jobs and had to change insurers,
you might not have been able to get some of your care covered
because of the preexisting condition exclusion.
Today, HIPAA helps to assure continued coverage for employees
and their dependents, regardless of preexisting conditions.
Insurers can impose only a 12-month waiting period for any
preexisting condition that has been diagnosed or treated within
the preceding 6 months. As long as you have maintained continuous
coverage without a break of more than 63 days, your prior health
insurance coverage will be credited toward the preexisting
condition exclusion period.
If you have had group health coverage
for at least 1 year and you change jobs and health plans, your
new plan can't impose another preexisting condition
exclusion period. If you have never been covered by an employer's
group plan and you start a new job that offers such a plan,
you may be subject to a 12-month preexisting condition waiting
period. Federal law also makes it easier for you to get individual
insurance under certain situations. You may, however, have
to pay a higher premium for individual insurance if you have
a preexisting condition.
If you have not had coverage previously and you are unable
to get insurance on your own, you should check with your State
insurance commissioner to see if your State has a high-risk
pool (described previously in this booklet). You can find the
phone number for your State insurance commissioner in the blue
pages of your local phone book.