Question
What is the name of your state? Maryland
I have been doing mission work in Mexico this past year, and our organization does not (unfortunately) provide insurance. Up till now we have gone without. I spoke to a doctor friend of mine with regard to a health issue that I have been experiencing. He recommended that I get health insurance before having any testing done so that future treatments will be covered (avoiding pre-existing cond. clauses). Well, I have been researching and I have a couple of questions:
1. If I go on some kind of individual insurance policy, and I am diagnosed with a problem, will I later be able to switch to a group coverage plan (in other words, if I am diagnosed and my problem warrants coming home to the states for treatment, my husband will go back to his job and group coverage - can I switch to that from my individual plan with my new diagnosis?) And how is this different from coming onto a group insurance plan from having NO insurance (with regard to "pre-existing conditions")?
2. I can have the testing I need done cheaply in Mexico. But the health ins. plans I am looking at don't cover MX. We can afford the tests right now, but will my policy recognize that I was diagnosed while under their coverage if they don't actually pay for the testing?
Any advise would be incredibly helpful!! Thank you in advance!
Answer
1. If I go on some kind of individual insurance policy, and I am diagnosed with a problem, will I later be able to switch to a group coverage plan (in other words, if I am diagnosed and my problem warrants coming home to the states for treatment, my husband will go back to his job and group coverage - can I switch to that from my individual plan with my new diagnosis?) And how is this different from coming onto a group insurance plan from having NO insurance (with regard to "pre-existing conditions")?
The Health Insurance Portability and Accountability Act (HIPAA) states all employees of businesses that offer health insurance as a benefit are eligible for guaranteed-issue insurance.
The plan may not exclude coverage for any pre-existing condition for more than 12 months after your enrollment date (18 months for a late enrollee).
Frequently Asked Questions about Portability of Health Coverage and HIPAA
2. I can have the testing I need done cheaply in Mexico. But the health ins. plans I am looking at don't cover MX. We can afford the tests right now, but will my policy recognize that I was diagnosed while under their coverage if they don't actually pay for the testing?
Your Insurance carrier will have no idea what happens in Mexico unless chart notes or claims are submitted.
Aditional Information
What is a pre-existing condition?
A preexisting condition is a medical condition present before your enrollment date in any new group health plan.
Under HIPAA, the only preexisting conditions that may be excluded under a preexisting condition exclusion are those for which medical advise, diagnosis, care or treatment was recommended or received within the 6-month period before your enrollment date. (Your enrollment date is your first day of coverage, or if there is a waiting period to get into the plan, the first day of the waiting period.)
If you had a medical condition in the past, but have not received any medical advise, diagnosis, care or treatment within the 6 months prior to your enrollment date in the plan, your old condition is not a preexisting condition to which an exclusion can be applied. Moreover, under HIPAA, preexisting condition exclusions cannot be applied to pregnancy, regardless of whether the woman had previous health coverage.
In addition, a preexisting condition exclusion cannot be applied to a newborn, adopted child under age 18, or a child under age 18 placed for adoption as long as the child became covered under health coverage within 30 days of the birth, adoption or placement for adoption and provided that the child does not incur a subsequent 63-day break in coverage.
Finally, genetic information may not be treated as a preexisting condition in the absence of a diagnosis. If your coverage is through an insurance company or offered through an HMO, state law may provide additional protections.
Answer
Averad,
Would a preventive medication considered a treatment? A person had a heart attack more than a year ago, did not receive any treatment for the condition (i.e. damage to the heart when part of it is not functioning to its full capacity), but has been taking a prescription medication to ease the heart function: keep blood pressure low (it was not high to begin with, just not to let it go high) and help to relax the heart muscle.
Is this a preexisting condition?
Another thing: how do insurance companies find out about previous diagnosis and such if a person was not insured at that time?
Thank you.
Answer
Would a preventive medication considered a treatment? A person had a heart attack more than a year ago, did not receive any treatment for the condition (i.e. damage to the heart when part of it is not functioning to its full capacity), but has been taking a prescription medication to ease the heart function: keep blood pressure low (it was not high to begin with, just not to let it go high) and help to relax the heart muscle.
Is this a pre-existing condition?
Yes, because the member did received treatment(at least one office call to receive the prescription) and a prescription. However it depends on what services the member received and without the claims or documentation I cannot give you a deffinate answer.
Another thing: how do insurance companies find out about previous diagnosis and such if a person was not insured at that time?
A medical examination is the easiest way