pre existing health insurance conditions are one of the most difficult life circumstances to face. There is no price for a person’s health, yet it is the irony of life that produces the situation where the person who needs insurance the most is not able to get it and the person who does not really have a current need for the coverage can get it.
One of the questions that most people who have challenges getting health insurance is will my current health condition be covered with the new legislation around pre exhisting health insurance plans.
It depends on where you live as far as the items that are covered, but if you live in Ohio and have a per-existing health condition then the link below is the most current anc comprehensive list I could find to let you know where your health condition lands on the scale of being covered or not being covered.
I would highly advise that you take a look at all of your options and make sure that you are asking questions to be sure that you don’t get any unpleasant surprises. In general, health insurance is covering less and less and health costs are going higher and higher so research is your friend.
The search for the best pre-existing health insurance is one that really will never end. It is more of a battle than a search because pre-existing health challenges such as pregnancy and a myriad of other conditions will always be on the forefront of health insurance and the many debates.
Pre-existing travel insurance is basically the same circumstances. So let’s start with the definition of a pre-existing health condition when it comes to travel insurance: “A Pre-Existing Medical Condition is any medical condition (no matter how minor), which manifested itself, became acute or exhibited symptoms which would have caused one to seek diagnosis, care or treatment; or which medical advice, diagnosis, care or treatment was recommended or received; or required taking prescribed drugs or medicine, unless the condition for which the prescribed drug or medicine is taken remains controlled without any change in the required prescription; or required medical treatment or treatment was recommended by a Legally Qualified Physician during the 60 or 180 day Lookback Period prior to the day you buy a travel insurance policy.”
Not all companies have the same definition, but most are right along these lines.
Insurance terms like “look back period” are basically what they say. In other words, when it comes to getting coverage insurance companies will not only take a look at the coverage you have in force as well as the medical condition you were in at the time of the application as well as the medical condition you were in up to as much as 6 months or 180 days PRIOR to your application.
Logically, it makes sense in order to protect the insurance companies from basically buying an expensive medical claim, but only receiving a few months premium in return, but the real challenge for policy holders is that the insurance companies can be a bit vague in what they can use as a pre-existing condition. So the many challenging situations that you often read about come about as a result of the insurance companies denying a claim based on what they will call a pre-existing condition.
So when you go to buy your travel insurance be sure to read the fine print. It has been said that “the good lord giveth and the fine print taketh away” and this phrase very well could be grounded in the insurance world.
When we think of pre existing conditions, we often think of health problems such as heart problems, diabetes, depression and a host of other medical conditions that might preclude a person from having their pre existing health condition covered by insurance in Ohio, as well as the rest of the nation.
But one pre existing condition that many do not understand, and can be a reason for a woman being turned down for insurance benefits is pregnancy. Shockingly-While it is not an illness, it is treated like an illness by insurance companies.
The question is, what happens to a woman who is pregnant and using her COBRA benefits at the same time? It can be a little tricky, but I want to help sort this one out.
If a woman is already on COBRA, then the group plan benefits that she will have access to will be the same as when she was employed. However, this only applies if she has her baby BEFORE her COBRA benefits end. The standard COBRA benefits last 18 months in most situations. If she becomes pregnant in month 2 of her eligible period, then in month 11 she will have her hospital and other medical expenses covered. On the other hand, if a woman becomes pregnant during the 12th month of her COBRA eligibility, then she most probably will not have coverage when she has her baby as her COBRA benefits will have terminated at month 18 (3 months prior to the birth).
So what does a pregnant woman on COBRA do?
First, a woman who is in the COBRA process should understand that Federal law (under HIPPA) bars an insurance company from considering her pregnancy as a pre existing condition IF she becomes eligible under another group plan. The emphasis here is on the GROUP plan. That is of course if the employer’s group plan covers pregnancy for every employee.
However, what about the person who moves from COBRA to a private plan of insurance?
Unfortunately, the HIPPA law only applies to group health plans. If a woman has moved from her HIPPA plan to a private plan, her pregnancy can then be viewed as any other pre existing condition and payment for her prenatal care and delivery most probably will not be covered. This is assuming of course that the individual health plan does not cover pregnancy as most don’t- and fewer will in the future.
You can see then that timing regarding pregnancies can make a whole lot of difference while being COBRA dependent, and one has to be a bit crafty so to speak to increase the chances of having coverage that a woman needs for the birth of her beautiful baby.
My COBRA is running out- now what???
Recently I had a conversation with a person regarding Ohio COBRA health benefits running out and how Ohio pre existing health conditions impacts COBRA ending. There are very view things that can cause as much concern as when a person with pre existing health conditions runs is facing COBRA health coverage terminating. Hopefully, the following information will help you feel that you have a little more control than you think, and will help you face running out of COBRA benefits feeling more empowered.
1) Don’t Panic
Even though this sounds a bit simplistic, it is always better to approach a health insurance challenge like this with a mind set that allows you to make good decisions. Is the thought of losing your COBRA benefits frightening? You bet. But try to shift your mindset to seeing this situation as a challenge as opposed to a problem. Facing tough situations that are challenging, instead of just being problems, seems to imply that we have some control. A mountain climber sees the next rock as something to be overcome- no way is he/she going to give up climbing. They just do not see things as problems. If so, seeing a problem in front of the climber would lower the climbers outlook, and possibilities of failure would become a nagging thought. We do not want to fall in this sort of trap.
We need to discover the CLIMBER within us. Simply put, addressing the challenge of overcoming difficulty of your COBRA coverage ending soon is something we can work to correct. And we will.
2) A Healthy Perspective on Rejection
At some point in planning to obtain health insurance coverage, we will try to qualify for a private insurance plan. However, given our pre existing health challenges we very well might have our applications rejected- or turned down. But when this happens, we should in no way translate our rejected application, into a mindset that we personally have been rejected. Note the difference? People often struggle with this but we must understand that our value is in no way determined by an insurance company saying NO to the APPLICATION.
When we think it through., an application goes to the insurance company’s underwriter (underwriters are the health insurance employees who make the decisions regarding the acceptance or the rejection of the application). The underwriter sees it as just more paperwork to handle along with all the many other
applications. The company does not sit down with you. They do not get a tour through your home. They do not have the pleasure of meeting your family and friends. For certain, they would find you to be a very enjoyable person. You would probably be seen as a successful person in their eyes. However, the application that has been rejected is just that, a decision to not extend coverage given information written down on paper or received over the computer.
Certainly, I am not defending all of the insurance company methods- and sometimes their intent.
3) Making Sense of HIPPA
The HIPPA law can help many people who are soon to be uninsurable. If you are moving from one group plan to another, and it is within 63 days from your last day of COBRA coverage, then your pre-existing conditions cannot be held against you. Otherwise, the new employer is legally blind to your health. You cannot be
rejected and there will not be any waiting periods other than what their standard may be for ALL new employees.
If you are seeking coverage from a company who issues private health insurance policies, then the company may have to accept you, but your premiums will be increased given your pre existing health conditions.
A different couple recently came to my office wanting me to shop for health insurance coverage for them both. As they shared more of their situation with me, unfortunately it was apparent that they would not meet the guidelines of any of the insurance companies that I sell for. The good news- they were both HIPPA eligible. (less than 63 days since their last day of being covered by HIPPA). The bad news- the average price for their new policy was going to be more than $1,800 per month. There was also a 1 year waiting period for treatment for both of their previous health conditions.
Fortunately, they learned about our pre existing health insurance plans available to them here in Ohio. They were very relieved at how many ways their healthcare concerns were now going to be taken care of. But what a roller coaster ride of emotions. I see this on a daily basis. The fear of not being able to obtain adequate coverage for a reasonable price should no longer be a legitimate fear with our pre existing plans available to you.
Ohio pre existing health insurance condition stories. Is it just us?
We all have talked and heard stories of people Ohio having pre existing health insurance conditions. Someone recently asked me if only Ohio pre existing health insurance conditions made the headlines. Well, please read the below.
By Jan Jarvis | The Fort Worth Star-Telegram
At birth, Houston Tracy let out a single loud cry before his father cut the cord and handed him to a nurse.
Instantly, Doug Tracy knew something was wrong with his son.
“He wasn’t turning pink fast enough,” Tracy said. “When they listened to his chest, they realized he had an issue.”
That turned out to be d-transposition of the great arteries, a defect in which the two major vessels that carry blood away from the heart are reversed. The condition causes babies to turn blue.
Surgery would correct it, but within days of Houston’s birth March 15, Tracy learned that his application for health insurance to cover his son had been denied.
The reason: a pre-existing condition.
“How can he have a pre-existing condition if the baby didn’t exist until now?” Tracy asked.
(To read the entire article please Google the above mentioned reporter)
Fortunately, in Ohio pre existing health insurance is available to those who need it. But you won’t find coverage through any Ohio pre existing health insurance pool though. They just don’t exist yet.
And when they do, Ohio pre existing conditions health insurance pools may cost an extraordinary amount of money. Yes, the health bill passed, but there is so much that needs to be accomplished before people with Ohio pre existing health insurance conditions will be able to afford pre existing health insurance.
In the meantime, we do have some great options.
To hear more about affordable options available to you TODAY please give me a call and if you’re an Ohio resident I will be happy to help you get protected.
Probably the largest single worry that many Ohio residents have is coverage for pre-existing health conditions in Ohio… especially when you switch jobs. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) helps assure that those with pre existing health problems in Ohio continue health insurance coverage for employees and their dependents.
That law which affects not only those in Ohio with pre existing health conditions, but all states in the US, imposes limitations on exclusion of coverage for pre-existing conditions, provides credit for prior health insurance coverage and a method to provide certificates regarding such prior health coverage to a new group health plan, prohibits discrimination in enrollment and the premiums paid by employees and their dependents based on health factors, and other protections for obtaining Ohio health insurance – both as to employees and to employers sponsoring a health insurance plan that will cover those in Ohio with pre-existing health conditions.
The major benefit of this legislation for most employees in Ohio, is that when they have been covered by a group health insurance plan for more than 12 months (or an individual policy, by Medicaid, Medicare, or a public health plan), there will be no pre-existing health conditions exclusion in Ohio of new group health insurance when the employee enrolls as a participant in a new group health insurance plan.
What great news for the vastly underrepresented Ohio residents who suffer with pre-existing health conditions.
If, for example, you obtained medical advice, care or treatment for a condition 3 months ago, and had an individual or group insurance plan for the past year, your new Ohio group health insurance plan must not exclude coverage for that condition (Ohio pre-existing conditions exclusion not enforceable due to HIPAA).
This has been great news for many in Ohio with pre-existing health conditions. But more needs to be done for those who need Ohio pre-existing health insurance, as so many need it.
Some wonder exactly what to expect, and when the time will come when they will be able to buy their own health coverage plans. Those with pre existing conditions in Ohio are hoping that finally, their rejections from the health insurance companies will come soon. What happens now?
The first thing that is so disappointing to know is that health insurance companies will still be able to deny those with pre existing conditions until 2014. That is the date that congress and the Obama administration selected as the year that no person will be denied from buying their own individual health insurance plans- including those with pre existing conditions here in Ohio.
Now don’t get me wrong. The road to getting there is full of positive news, and beginning in January of 2011, there will be changes that will remind us that we are getting closer.
Beginning in January 2010, there will be no maximum limits that health insurance companies can cap on any health insurance plan. In Ohio, like the remainder of the states, if a person’s treatment for health conditions exceeds the normal 2 to 3 million dollars that current medical insurance covers them for, will no longer be precluded from obtaining additional health insurance paid treatment. There will absolutely be no maximum amount of coverage on health insurance plans. Eventually, this will be most important to those who have pre existing health conditions and are the ones who need medical treatment the most.
No more will those will very challenging individual health conditions have to worry if they will simply have money to begin, or continue their health treatment. What a burden that will be lifted from our friends and family here in Ohio with the availability to obtain worry free (as far as money is concerned) continued treatment. Especially those in Ohio with pre existing health conditions.