Having a medical condition like diabetes or cancer is stressful. The last thing you want to worry about is getting health coverage. And now, you won’t have to. There’s a provision within the healthcare reform law that requires health plans to offer coverage to people even if they have a preexisting health condition.
What is a Preexisting Health Condition?
A preexisting health condition is a medical illness or problem you had before you enrolled in health coverage. A condition can be considered preexisting whether or not a doctor provided any advice, diagnosis, care or treatment.
What Does the Provision Mean?
Under this provision, health plans can’t deny you coverage if you have a preexisting condition. It also means a health plan must cover treatments for your preexisting health condition if the type of treatment is outlined under the plan.
When is this Provision Effective?
This provision first took effect for plan years* beginning on or after September 23, 2010, but it only applied to children under age 19. However, all health plans are required to offer coverage for preexisting health conditions to everyone (no matter their age) for plan years beginning on or after January 1, 2014. This provision of healthcare reform does not apply to grandfathered individual health insurance policies.
*Plan year is the time period during which things like deductibles and coinsurance accumulate. This may or may not be a regular calendar year. For example, a plan year could be January 1st through December 31st or July 1st through June 30th of the following year.
Learn more about preexisting conditions and other aspects of healthcare reform in our Healthcare Reform section.