Pre-Existing Conditions
Francisco, 35, a self-employed contractor, had a group plan through his professional association. When the plan cancelled its contract with the association, Francisco was worried he wouldn’t be able to find another policy. “Then I found out I could get a HIPAA plan, even though I have diabetes.”
A pre-existing condition is an illness or injury that you have before you join a health plan.
Topics on this page
Group plans and pre-existing conditions
A group plan, like one you have through your job, cannot refuse to cover you or decide to charge you more if you have a pre-existing condition.
In some cases, a group plan can make you wait before it will cover care for a pre-existing condition. The longest you can have to wait is six months.
- There is no waiting period if you have not had treatment for the condition in the past six months.
- There is no waiting period if you have had health coverage for at least six months and it has not been more than 62 days since your last insurance ended.
- You will wait less than six months if you had other health coverage for less than six months and it has not been more than 62 days since your last insurance ended.
Individual plans and pre-existing conditions
- In many cases, an individual health plan can refuse to cover you or decide to charge you more if you have a pre-existing condition.
- There are laws that protect your right to buy individual coverage if you have had a group health plan. HIPAA and conversion plans are kinds of individual coverage you can buy.
- Learn more about your rights to get individual insurance .
MRMIP
This is the California Major Risk Medical Insurance Program . It is a program for people with serious health problems who have difficulty buying individual health insurance because of their medical history. Call 1-800-289-6574.
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