Does Your Insurance Have a Pre-Existing Conditions Clause

A pre-existing conditions clause can prevent you from receiving coverage under your health insurance plan.

Pre-existing medical conditions can throw a wrench into a claim made through certain health insurance policies. While a pre-existing condition doesn’t necessarily void coverage, a pre-existing condition clause can get in the way of the coverage you need under your insurance plan.

What is a Pre-Existing Condition?

A pre-existing condition is a medical condition that existed prior to your purchase of health insurance. Generally, a pre-existing condition is one for which you have received treatment or diagnosis prior to purchasing your current health insurance plan. Common pre-existing conditions include things like asthma, diabetes, heart disease, and other chronic conditions.

Can a Pre-Existing Condition Impede Your Ability to Get Medical Coverage?

Under current law, health insurance companies may not refuse to cover you or charge you more for insurance because of a pre-existing condition. Further, your health insurance provider cannot limit the benefits you receive for that condition either.

However, there is a notable exception to that rule. The rule only applies to insurance plans that were purchased after March 23, 2010. Any policies purchased before that date are considered to be “grandfathered in” for the purposes of the ACA. Here’s what HealthCare.gov has to say about grandfathered policies:

“These plans weren’t sold through the Marketplace, but by insurance companies, agents, or brokers. They may not include some rights and protections provided under the Affordable Care Act. Plans may lose “grandfathered” status if they make certain significant changes that reduce benefits or increase costs to consumers. A health plan must disclose whether it considers itself a grandfathered plan.  (Note: If you’re in a group health plan, the date you joined may not reflect the date the plan was created. New employees and family members may be added to existing grandfathered group plans after March 23, 2010).”

If you have a grandfathered plan, you may run into some trouble getting a claim approved for certain pre-existing conditions.

Certain UHSM health sharing programs include member sharing for pre-existing conditions.

Health Sharing Ministries May Cover Pre-Existing Conditions

Over the recent past, health sharing ministries have been growing in popularity among Americans looking for a viable alternative to health insurance. Health sharing ministries allow for more flexibility in the types of physicians that members can see while still being covered and don’t require enrollment to take place during a few short weeks of the year as is the case with insurance plans.

Further, members of health sharing programs can save up to 30% to 40% on coverage compared to traditional health insurance.

And when it comes to pre-existing medical conditions, these plans are also accommodating members where appropriate. At UHSM, membership is now being accepted for those with some pre-existing conditions, such as cancer or heart conditions. Acceptance began on January 1, 2021, with details on the specifics still being finalized.

As long as you clear a review process at the time of application, you’ll be accepted along with your pre-existing condition.

To find out more about membership with UHSM, get in touch with a representative today or click here to see how much you can save with a health share program.