Pre-existing Conditions and Eligibility for IFP's

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Individual health insurance plans differ in the way pre-existing conditions are managed from Group Insurance plans. Group plans are able to spread the risk of pre-existing conditions across a greater number of people. Individual health insurance plans are specific to the individual and are therefore managed in a more immediate way.

The simplest definition within health insurance of a pre-existing condition is: a symptom, injury, illness or medical condition you experienced before you start on a new plan. This is true even if you have not seen a doctor for any of these things.

Because there are so many rules and variables when dealing with pre-existing conditions, the subject can appear complicated and puzzling.

To help us understand how health insurance companies approach the subject it is important to see how they view pre-existing conditions. Because insurance is based upon the assessment and calculation of risk, a health insurance company will see a pre-existing condition as either low risk, risk, high risk, or a certain risk depending on the illness, condition and the patient.

Any illness or medical condition viewed as high risk or, a certain risk, will be excluded by the insurance company. For conditions or illnesses that are considered a low risk, the insurance company will want to take reasonable steps to minimize those risks. Those steps will depend on factors such as the type of plan, the illness or condition and the patient’s medical and coverage history.

Under HIPAA, there are some plans available to people seeking individual insurance plans, that do not have pre-existing conditions attached. These plans are only available to 'eligible individuals' that fit the requirements. These plans have very high monthly premiums and are often used as a last resort.

Apart from HIPAA, some states require individual health plans to provide coverage to individuals with pre-existing conditions. Again these plans are expensive with large monthly premiums attached.

If you have a pre-existing condition, and fear you may be excluded from obtaining an individual health insurance policy, it is always advisable to talk to a qualified broker or advisor before you apply. You do not want a health insurance rejection on your file and there may be ways in which an acceptable solution can be found.


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