Health insurance and pre-existing conditions

lilblu

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I may be getting my first job soon. The job should include health insurance. I need to know how pre-existing conditions work so I can decide if I should see a doctor now or wait until after I get insurance.

From what I've read, sometimes insurance companies won't cover pre-existing conditions for a certain amount of time depending on the state. I believe my state has a maximum of 12 months. I think sometimes it also depends on if you've recently been insured or not.

It's very unclear as to the official definition of a pre-existing condition. I've seen two different definitions. One says a pre-existing condition is a condition that has been previously treated by a doctor. Other definitions say it's a condition that existed before the new health insurance started. So I take that to mean that if I had a toothache and went to the dentist after I got insurance, I could be denied because the tooth problem actually existed before the insurance started even though I never sought treatment for it before.

How would anyone know if I even had a pre-existing condition? I can't imagine insurance companies would contact every doctor asking for my records. So how would they know? Also, since a lot of doctors toss out records of people who haven't been there in more than 7 years (that's happened to me before), it seems like there wouldn't be any proof. I'm not even sure of all the things I've been diagnosed with. Of course, I've also heard that insurance companies sometimes make people get physical evaluations at the start of their coverage. I assume that has something to do with pre-existing conditions.

I am very confused about this stuff. Does anyone know anything about this? I'm guessing I would be better off if I just waited to go to a doctor until after I get a job and get insurance through the job.
 

emrldsky

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Nuh uh...might give me away!
Most often (though some skeezier insurance companies might differ), a pre-existing condition is something that will be with you your entire life or terminal. An example would be diabetes.

My SIL has type I diabetes and if she's without ANY insurance for longer than 60 days, most insurances won't cover her. She has to consistently keep coverage, no matter how expensive, in order for another company to cover her.

Things like the cold, flu, injury (i.e., break, cut, etc.) and so on are not typically considered pre-existing.

It really depends on the insurance company. I think if you're not currently sick or feeling ill, it'll be better to wait until you get the job with benefits and then see a doctor.
 

strange_wings

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Ask the emplorer. It depends on who they use and what plan they offer their employees. As to what the exclusion period may be. Often health insurance won't go into effect until after a certain period. What they consider pre-existing varies. My husband's always had his asthma covered by different companies, though he was diagnosed with it when he was 8.

Usually they don't look that far back - they'll look at what you've been treated for in the last 6 months to a year. Though big stuff that could be expensive for them may get noticed.

If you have something now that will compromise your ablity to work you'll have to decide whether you should wait or not.

It'll be nice when this is no longer an issue…
 

carolina

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Usually when it is a work/group insurance policy, you do not have this worry. They won't deny you.
You would have this worry when getting an individual policy on your own, outside of work - then they would have the choice of insuring you or not. But through work you should be just fine.
What you will have to deal with is when your insurance will kick in - some companies insurance start within a month, some within three months.
In my current company, my coverage started within 30 days; in the old company after 90 days.
With work insurance, when a company has insurance, they insure all employees.
As far as your question for pre-existing condition:
Condition not cured. So basically, a condition that is known, and they will have to deal with it.
So, if you had a condition that was treated and cured, that is not considered a pre-existing condition.
I have severe migraines for example and take precription meds, quite expensive, on the hundreds, and there wasn't an issue at all.
Don't worry about it - HR will guide you through filling up the forms, and they won't deny you

Oh, and currently having insurance or not also doesn't matter at all... It only matters when again, buying and individual insurance policy, and not when getting insurance through work.
When getting insurance through work - called "Group Policy" everything is way more forgiving. You get the insurance, you get the coverage offered to the employer. They will not make exceptions to your case because of your personal history.
Your employer is basically buying a package deal of a number of policies with a certain sets of benefits.... Which is why it is a huge advantage of getting insurance through work nowadays... At least you don't have so many worries when your employer gets a good policy.
 
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