Preexisting Conditions ***
MR. WATSON: Before the Affordable Health Care Act most policies excluded preexisting conditions. This was designed to protect the company against "adverse selection ". Folks knew they were sick and facing huge medical costs and then raced out to buy health insurance.
WOMAN: A condition you had before you had the insurance?
MR. WATSON: Yep. Here it is - it's one that existed before the policy's effective date, and one you didn't tell them about.
WOMAN: Can they still do that?
MR. WATSON: With some policies yes. The Affordable Health Care Act eliminated preexisting exclusions for ACA medical expense plans (Major Medical, PPOs, HMOs.).But before the ACA, the Health Insurance Portability & Accountability Act, HIPAA, limited the time these could be excluded. Maybe a year or more before the preexisting condition was covered. But, not any more. Preexisting conditions are covered.
In the past, health insurance contracts excluded from coverage pre-existing conditions and imposed lifetime or annual benefit limits. If a medical condition existed before the effective date of the contract, this could be excluded from coverage for a certain period. However, the Affordable Health Care Act (ACA) now prevents insurers from excluding pre-existing conditions and does not allow a policy to have annual or lifetime maximums. But not all policies fall under the ACA.
Most employer sponsored group plans, as well as HMOs, PPOs, POS, and health plans bought through the Health Insurance Marketplace fall under the requirements of the ACA. Others do not.
Some products that help pay for medical services don't qualify. Examples include:
- Coverage only for vision care or dental care
- Coverage only for a specific disease or condition
- Workers' compensation
- Short term medical expense policies