Grace Period for Pre-Existing Conditions After Being Uninsured?

October 20, 2005 1:31 PM

In Illinois, or nationwide, is there a policy or law that says that if you become uninsured, but resume health coverage within X number of days, you do not need to worry about pre-existing conditions?

Right now, I know that if you go from one job to another continuously, you do not need to worry about pre-existing conditions with your new health insurance.

I remember someone -- I want to say it was someone involved in the healthcare industry, perhaps even an insurance company customer service rep -- telling me that there was a law (either statewide in Illinois, or federally) stating that if you resume coverage within a certain number of days, you don't need to worry about the new company denying coverage for pre-existing conditions.

I understand COBRA, but the premium in question is unfortunately too costly for me to take advantage of, given present financial circumstances, and I am similarly not in a situation where I can borrow the amount in question.

Although answers relating to obtaining temporary health coverage would not necessarily be unhelpful, my concern is more the original question. I have Googled for it, but must not be using the right combination of search terms, as I'm getting nothing.

posted by WCityMike to health & fitness (8 comments total)

That's HIPAA and unless there are other circumstances it's 63 days.
posted by m@ at 1:46 PM on October 20, 2005

Clicky.
posted by ubernostrum at 1:59 PM on October 20, 2005

Even if your break in coverage is longer than 63 days, an insurer cannot deny you coverage of your preexisting condition for longer than 12 months if you enroll in the employer's group plan. The requirements vary, but usually an insurance company will only "look back" to see if the preexisting condition was diagnosed or treated in the six months prior to enrollment.
posted by lunalaguna at 2:01 PM on October 20, 2005

do you HAVE pre-existing conditions? if not, disregard the concern, as it's unlikely to affect you. you can usually retro-actively elect COBRA should you need it in this case.

if you do, here's another HIPAA link. be sure to get a certificate of coverage from your current/previous carrier. note that another good point here is at worst, pre-existing condition exclusion is also finite under HIPAA (typically no more than 12 months). scary if your background demands care, but it's a positive at least.
posted by kcm at 2:01 PM on October 20, 2005

Be careful about assuming you don't have pre-existing conditions; Kaiser Permanente refused to insure me because of my pre-existing condition of depression - I take a low dose of prozac, which is so cheap as a generic that 3 months supply costs me less than dinner out. What they'll exclude or screw you over can be very minor.

Aside from that, don't be without health insurance. I have a friend who's in his 7th year of making payments on a simple appendectomy. At the age he was when he had the problem he could have been insured for as little as $40 a month. Imagine how much a major injury could have amounted up to.

COBRA is a LOT more expensive than many other alternatives. When I was a 31-year-old non-smoker I was able to buy BlueCross/BlueShield coverage which was actually pretty good for about $110 a month. There were some options for about $15 less but it wasn't worth the savings.

You can go look on HealthInsurance.com and I think you'll be suprised how cheaply you can get coverage if your only data point is COBRA quotes. Punching in your zip code and assuming you're 30 there are plans as low as $45 a month.
posted by phearlez at 3:53 PM on October 20, 2005

As everyone has said, HIPAA will protect you from a new employer's group health plan's pre-existing condition exclusion as long as you don't have more than a 63 day gap in creditable coverage. If you get a job with health insurance coverage starting within 63 days after your last day at your old job, you have nothing to worry about.

Lots of group health plans have no exclusions for pre-existing conditions, so if you do happen to get a job with an employer with a plan like that, you won't have to worry about that stuff. Then, all you have to worry about is not getting hit by a bus when you're uninsured. Some of this worry can be alleviated by careful COBRA planning -- you have 60 days to elect (from the date when the notice was given to you), and then 45 days to pay the back premium. So, you can elect after 59 days and then wait another 44 days to pay (or not pay as the case may be) and if anything happens to you in that 105 day window, you'll have insurance. Keep in mind that if you do get in an accident and want the insurance to cover it, you'll be responsible for the back premium.

COBRA is a LOT more expensive than many other alternatives.

This is mostly not true. COBRA premiums are based on whatever the group insurance premiums are where you're employed and, as a whole, they are much cheaper than individual insurance. If you do happen to fall into an attractive risk category (like phearlez), you can sometimes get a cheap individual rate, but this is the exception, not the rule. Many, many states are not guaranteed issue individual health insurance states, which means that they can jack up your rates based on unfavorable answers on a health questionnaire.

If you're trying hard to find a new job with health coverage but you think there might be a month between jobs, I would not worry about that. If anything happens, you can always retroactively COBRA.
posted by MarkAnd at 5:03 PM on October 20, 2005

One of the problems with the "pre-existing condition" thing though is that if you get individual health insurance, they will make you fill out a long form listing every recent time you have been to the doctor, and everything you have been diagnosed with. At that point, they can either decline to offer you coverage, or only offer you coverage with the restriction that care for one or more of your existing conditions is not part of the insurance. As I understand it, HIPPA does not override this. Thus, if you have some sort of serious medical condition, you pretty much have to get COBRA, and get a new job before it runs out, as individual insurance will either be too expensive or will not cover a serious condition. I believe some states have programs for people with serious conditions, but I'm pretty sure those are really expensive.
posted by cameldrv at 4:28 AM on October 21, 2005

Oh, also, ehealthinsurance.com is where I got my individual policy. If you are in good health, it's reasonably cheap ($100 a month or so if you're young and in fairly good health) for catastrophic only coverage ($2600 deductible).
posted by cameldrv at 4:30 AM on October 21, 2005