Is it common to have insurance co. not cover previously existing conditions folowing a lapse in coverage?

Question

I went off my parent's health insurance and have yet to obtain coverage from my employer. I have been uninsured for almost three months. I am generally healthy but have a few health concerns for which I see specialists and am on 5 Rx medications to treat.

My dad keeps on telling me that if there is a lapse in my health insurance coverage, the new company I get coverage with could decide to not cover me for my pre-existing conditions. Is this common? What are the odds of this happening? Thank you for any insight!

I'm in California. Long story, but I think that I'll be the only person on this specific health plan set up by my employer.

Answer 1

It *is* possible for an employer's health insurance plan to have a pre-existing conditions clause, so please disregard the first response. She is 100% wrong.

Truthfully, there's not much you can do about it now if you haven't been covered for 3 months...in order to waive a pre-existing clause, the break in coverage must be 63 days or less.

You'll just have to wait and see if your employer's health plan has a pre-existing clause or not. Maybe you'll get lucky and it won't. I'd say your odds are mabye 50-50.

Here's what will happen *if* your policy has a pre-existing clause, given that you've had a 3 month break in coverage:

You'll have the insurance policy. Anything not related to a pre-existing condition will be covered as normal under the terms of the policy. Anything related to a condition that you've previously had treated (including taking medication for) will not be covered for the pre-existing period. (Typically 1 year, though I've seen policies where its only 6 months.)

You will be liable for the full amount of any charges billed by your providers relating to those conditions during that time. (Including the medications.) After your pre-existing period is over, those charges will be covered as normal. (BTW - you won't be able to fool the insurance company into thinking you haven't been treated before, because they can and will request documentation from your medical providers.)


At any rate...hopefully you'll get lucky and you won't have a pre-existing clause. Then your break in coverage won't matter.

Answer 2

It's not 'common', it's pretty much the rule of the road. The chances of that happening are, well, about 100%.

The magic number is 63 days. They can't exclude any preexisting conditions, if the lapse in coverage is less than 63 days. You're beyond that now, so once you get added to your employer's plan, you'll have to wait out the 18 months with no coverage, until it kicks in again.

Answer 3

The answers to your question depends on what state you live in and how many employees are on your employers plan. For instance, in NJ if a group plan has more than 5 covered employees, they are not subject to pre existing conditions no matter what. If the group is under 5 and you have a lapse of more than 63 days, you would be subject to pre ex. Also, if you don't have 18 months of continuous coverage you are subject to pre ex. It differs from state to state.

Answer 4

That would only be an issue if you were to purchase insurance on your own. Since you'll be covered under a group policy with your employer, pre-existing conditions do not matter.

Answer 5

The odds of it occurring are very high. Many insurers exclude coverage on pre-existing conditions, at least for a period of time after you sign up for their coverage. If they did otherwise, folks would simply wait until they got sick, and then apply for coverage.