Many people have been denied coverage for health insurance based on a pre-existing condition, meaning a disease they have was diagnosed before their enrollment into a new insurance plan. Laws regarding acceptance into an insurance plan vary from state to state. The U.S. Department of Labor has released information regarding pre-existing conditions based on the Health Insurance Portability and Accountability Act (HIPAA) and the newer Senate legislation, the Patient Protection and Affordable Care Act (PPACA).
PPACA
Starting in September 2010, group health insurance plans can't exclude people with a condition that existed prior to gaining new health insurance coverage. In January 2014, no group medical insurance plan will be able to provide rules regarding excluding anyone based on a condition that existed prior to gaining coverage. Pre-existing disease as defined by PPACA is any condition that required medical treatment, advice, diagnosis, care or information gathered about you prior to enrolling into a new insurance program.
HIPAA
According to HIPAA, pre-existing conditions are defined as a condition that you have received medical treatment for in the past six months prior to enrollment in a new health insurance program. Under HIPAA, group employer insurance plans can't exclude a pre-existing condition you have for more than 12 months after enrollment. If you change employers, a new employer’s insurance plan can't exclude your pre-existing condition for more than 63 days after enrollment, which eliminates the 12-month exclusionary rule.
Credible Coverage
Credible coverage under the new laws regarding pre-existing conditions include insurance coverage you have had with COBRA benefits, state provided medical benefits, Indian Health Service, Medicare/Medicaid or another public health plan. This information can be used to provide continuum of care under a new health insurance plan. Your diagnosis codes can be obtained for use of what benefits you are potentially going to use and estimate the cost of benefits based on your medical history.
Discrimination Prohibitions
Discrimination prohibitions are put into place with the HIPAA regulations that state no one will be denied coverage based on health status. HIPAA also guarantees that lifetime coverage will not be limited for existing or pre-existing health issues.
Limitations
States have the right to make changes to the federal law where they see fit. Under PPACA, you are not protected from having restrictions on health benefits for pre-existing conditions. The insurance company may limit which services you receive, deductible/ copay charges could be higher, and other benefits could be limited.
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