Scan Medical Insurance

Group insurance and preexisting conditions?

I had a job with health insurance but lost it because of a work injury. The workmans comp is making it go through court to pay me so I have no income right now. My wife has a preexisting medical problem. I went onto COBRA insurance but it went over 100 percent in January and I could no longer afford to make payments on it. About March 5 I will go over the 63 day that I have to replace my insurance. I have found another job with insurance but it requires a back ground check that may take me over the 63 day time limit where they have to take preexisting conditions. What I need to know is if it is group insurance, do they cover preexisting conditions or will I end up losing coverage on her? If they do not cover preexisting conditions can I get insurance for a short time to cover that time? An insurance salesperson told me that short term insurance will probably hurt me instead of help me. That I don't understand because I have to keep insurance to keep her covered. Where do I go to get absolute rules pertaining to this? Any guidance will be greatly appreciated

Public Comments

1. Companies can put a pre-existing exclusion of 6 - 12 months (depending on your state) if you go without insurance for greater than 63 days. It is up to the employer to waive or impose the exclusion so it may or may not be applicable to your situation. Also, if you do go over the 63 days and the policy does have the exclusion they will still cover her, they just won't cover the pre-existing condition. Short term policies will not hurt in this situation. The agent was getting confused by HIPAA individual regulations. However, depending on the health condition she may not qualify for a short term policy. Here is the government website with more answers: http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html
2. The new group, is allowed to exclude coverage for preexisting conditions, for the same amount of time that she had her lapse. Short term insurance isn't going to count as "credible coverage", and won't cover her preexisting conditions. Most likely, you can't find private insurance for her, cheaper than COBRA. So if you go one week over, a 70 day lapse between the old policy and the new policy, they can exclude coverage for preexisting conditions for 70 days.
3. Once you go over the 63 day limit, group insurance will not cover preexisting conditions for the first 6-13 months that you have group insurance. After you have group insurance for 6-13 months, it will begin covering preexisting conditions. If you need insurance for a short period of time, the best thing to do is to get a regular, normal insurance policy, just like if you needed it for a long period of time, and cancel when you no longer need it. Short term insurance does not cover preexisting conditions, and is a bad deal for other reasons.