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Pre-Existing Conditions

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What if I have a pre-existing condition?

Regardless of any medical condition a person may have prior to when your coverage starts, insurance companies are required to abide by the rules in respect to the essential health benefits for pre-existing conditions.  This means that no insurance provider can reject you, refuse to pay, or let it affect what they charge for medical care. Pricing must also not affect what they charge based on gender.  With the exception of grandfathered plans, all insurance companies are required to recognize provide these benefits to pre-exiting condition customers. And of course all Marketplace plans, Medicaid and CHIP provide these essential health benefits as well.

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What if I am pregnant or adopt a child?

Pregnancy and adoption are categorized in the pre-existing condition field and will qualify you for a Special Enrollment Period to enroll or change plans.  Once enrolled, coverage will begin as soon as your plan begins.

With adoption, as mentioned above, you may enroll or change plans during open enrollment or a Special Enrollment Period and your new plan will take effect beginning on the date of birth or the start of adoption, not past 60 days of said date.


How are grandfathered plans affected by pre-existing conditions?

Grandfathered plans that are purchased independently from your employer, are not bound by the pre-existing conditions requirements. But once your grandfathered coverage year ends, you will qualify for a Special Enrollment Period, if necessary, and you can choose to purchase a Marketplace plan that fits the needs of you and your family.

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