A pre-existing condition is a medical condition you have had
in the past. With group plans you have little choice in the specific benefits
of the plan (these are determined by negotiations between the company and the
insurance carrier) but you also cannot be denied coverage under the group plan
no matter what prescriptions you may take or preexisting conditions you may
have. By insuring a large group of employees together under one plan of the
company’s choosing, individual employees are not medically underwritten, rather
the entire group is underwritten as a whole to determine the premium level
everyone will pay. Therefore, the amount you pay in premiums as well as the
quality of the coverage you receive are dependent not on how healthy you are or
what benefits you would like to have, but how healthy your group is as a whole
and what benefits the company has chosen for you. However, with individual
coverage each person who applies is medically underwritten and may be approved,
denied, or rated-up by the carrier depending on their health history in recent
months. It is important not to have a lapse in coverage of more than 63 days.
If you do, your new insurance carrier may refuse to cover treatment for
pre-existing conditions you may have such as asthma or acne for up to a year
after your policy goes into effect. In some states, the lapse in coverage time
allowed can be as little as 30 days. For this reason, having continuous health
insurance coverage is particularly important.
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