San Diegans for Healthcare Coverage, A Coalition for Health

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Affordable Coverage for Pre-Existing Conditions

Currently, adults with pre-existing conditions may be denied coverage, charged a higher premium, or have certain pre-existing conditions excluded from coverage for a period of time.  This will be prohibited in 2014 when several of the provisions of the Affordable Care Act are fully implemented.

Until then, insurance companies can ask you about pre-existing conditions that have been diagnosed or treated during a period of months (the “look back period”) prior to your application date. And they can research history on claims to ascertain if a pre-existing condition was unreported during the application process. The “look back period” varies by State.  In California it is 12 months if the individual policy covers one or two people (e.g. policy holder and spouse) and 6 months for Individual policies that cover three or more people (e.g. policy holder and family).

On the other hand, insurance companies are not allowed to ask about genetic tests or family history. And they may not turn you down, charge you more, or impose a pre-existing condition exclusion period because of your genetic information.

There are several affordable plans available for those who are denied Individual Health Plan coverage due to pre-existing conditions. For more information, go to the section on this website entitled, Pre-existing Conditions Insurance Plan.

Go Back to Coverage Today: Individuals and Families