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Pre-Existing Conditions In California Health Insurance

There seems to be a lot of confusion among California residents about pre-existing conditions as related to health insurance in the state of CA. There are some very important things to keep in mind but it is not rocket science! Here are some common questions concerning pre-existing conditions in California health insurance and how they affect you and your health plan options.

What is a pre-existing condition?

A pre-existing condition in CA individual health insurance is really any health issue within the last 10 years of the date of the health application (this is not a hard and fast rule but generally speaking 10 years is the absolute furthest back that an insurance company will look when in the underwriting process. Also, many companies will only look back 2 years or 5 years for specific types of pre-existing conditions). A pre-existing condition in CA group health insurance is any health issue within the last 6 months.

What different types of pre-existing conditions are there?

There are two main types of pre-existing conditions in the state of California; minor pre existing conditions and major pre existing conditions. Minor pre-existing conditions are things like high blood pressure, high cholesterol, and mild asthma. Major pre-existing conditions include cancer, heart disease and diabetes. The severity of the conditions, the frequency of the occurrence, and the timeline of the condition are all important factors that an insurance company takes into consideration when determining whether a particular health problem is a minor or major pre-existing condition.

How are pre-existing conditions handled?

Pre-existing conditions are handled a number of different ways in the state of California. On the group health insurance side as long as someone maintains continuous health insurance coverage then the insurance company will not exclude any pre-existing condition. If someone begins group health insurance without having had continuous coverage then the insurance company offering the group health plan has the right to look back 6 months and exclude any pre-existing conditions within those prior 6 months. In any case the insurance company offering the group health plan is unable to decline an individual based on their health history (this is why group health insurance in CA is approximately 2-3 times the cost of a comparable individual CA health plan).

On the individual health insurance side insurance companies can decline a person’s application based solely on the applicant’s health history. Most major pre-existing conditions will result in an automatic decline for individual health insurance in the state of California (unless the individual meets the requirements for a guaranteed issue California HIPAA health insurance plan).

Minor pre-existing conditions are typically handled one of two different ways: either the insurance company will cover everything and charge extra to cover the pre-existing conditions or the insurance company will rider (exclude) the pre-existing conditions and cover everything else (riders can be either for an indefinite time period or they can last for 6 months, 12 months, or some other time period).

The important thing in shopping for health insurance coverage in the state of California is to compare multiple insurance companies’ offers as the underwriting does vary to some degree from company to company. Be sure and compare health quotes from at least 3 different insurance companies. Take a few moments and compare quotes from 5 top insurance companies offering coverage in your home zip code by requesting free California health insurance quotes now!

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