With health care costs continually rising, obtaining health insurance coverage is more important than ever. However, people with a history of diseases or other conditions may find obtaining affordable coverage difficult. Most insurance companies will only provide limited heath insurance benefits to people with a history of certain diseases, and some may not provide coverage at all. However, group health insurance may provide these people with coverage at affordable rates.
Definitions
Group health insurance coverage is a health coverage policy offered through an employer or an association, rather than directly from a broker or insurance agent, according to the National Association of Health Underwriters. An association can be a trade organization, such as a writer's guild, in which all members share a common interest.
A pre-existing condition is a medical condition or illness that was present before application for health insurance coverage. Medical expenses for a pre-existing condition may have been covered by a previous health insurance policy.
Eligibility
You must be an employee of the company or a member of the organization offering the health insurance plan. Typically, you will have the opportunity to enroll in the group health insurance plan within a certain window of time after beginning employment or joining the organization.
Exclusionary Period
Group health insurers in the United States cannot deny enrollment for a pre-existing condition. However, they can impose up to a 12-month waiting period, called an exclusionary period, before you can receive benefits for care related to your pre-existing condition, according to the United States Department of Labor website. During this time, if you receive medical care for the condition, the group health insurer is not obligated to pay for the costs of this care.
This exclusionary period can be reduced under the Health Insurance Portability and Accountability Act if you were insured under another HIPAA creditable policy no more than 63 days before enrolling in a new group health plan. A HIPPA creditable policy is group or individual health coverage maintained before enrolling in the new employer or association's policy.
Individual states may reduce the exclusionary period, depending on state laws.
Look Back Period
United States federal law allows group health insurance companies to look at the last six months of your medical history when assessing pre-existing conditions. If you received no medical advice or treatment for your condition within the six-month period before enrollment, the group health insurer cannot impose an exclusionary period, according to the National Association of Health Underwriters.
Late Enrollment
If you miss the initial opportunity to enroll in the group health insurance plan, you will typically have to wait until the plan's next open enrollment period, which generally occurs once per calendar year. You are then considered a "late enrollee," but will not lose protection under HIPAA. However, the group health insurer can impose an 18-month exclusion for pre-existing conditions, instead of the 12-month period imposed on people who enroll at the first opportunity, according to the United States Department of Labor.
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