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Navigating Health Insurance in 2013 + Autoimmune Conditions

Are there any insurance coverage issues with autoimmune conditions – could I be cut off from health benefits (e.g., with small employers not subject to the new health care law) if I do not disclose a condition at the time it is known?

One of the most important protections under the Health Insurance Portability and Accountability Act (HIPAA) is that it helps those with preexisting conditions get health coverage.  In the past, some employers’ group health plans limited, or even denied, coverage if a new employee had such a condition before enrolling in the plan.  Under HIPAA, that is not allowed. If an insurance plan generally provides coverage for a particular condition but denies benefits to you because you had the condition before your coverage began, then HIPAA applies.

Under HIPAA, an insurance plan is allowed to look back only 6 months for a condition that was present before the start of coverage in a group health plan.  The law says that you can be denied coverage based on a preexisting condition only if you’ve received medical advice, diagnosis, care or treatment during the 6 months prior to your enrollment date in the plan.

So, if by chance you hadn’t been to the doctor for, say, your lupus in the 6 months leading up to the time you take the new job and want to be covered under their health insurance, you’re golden.  However, if you had received medical care for your lupus in the six-month period before your new job, which is probably likely for most of us, you might be out of luck.

If you fail to disclose a preexisting condition at the time you receive a new policy, the health insurance company can cancel or rescind the entire policy, and you will lose all coverage, rather than just coverage for the non-qualified condition.

Note that there is not a set list of illnesses that will be accepted or excluded by every insurance company.  Each company has conditions that it will accept and conditions that they won’t.  Many autoimmune conditions, including diabetes, multiple sclerosis and Crohn’s, are on the “iffy” list.

Keep in mind that some states have additional laws that may pertain to your situation, so you might want to consult a local expert.

Many of the provisions of the Affordable Care Act take effect next year in 2014, and one of them holds that insurers will no longer be able to turn down anyone with a preexisting condition.  Some of the details of the Affordable Care Act are still being hammered out, so you’ll want to keep abreast of the changes.

Further reading and resources

University of Washington: Can an Employer Legally Ask an Applicant About Current Illnesses?

Principal Financial Group: Discussing the Disability with Prospective Employers

Consumer Reports: Health Reform: Your Next Steps

United States Department of Labor:  Your Health Plan and HIPAA…Making the Law Work for You

AutoimmuneMom

About the Author
Gretchen Heber is an autoimmune mom and entrepreneur with more than 15 years of experience in online media. She has also worked with several daily newspapers across the United States, serving as a graphic designer, writer and editor.

This blog post was originally published by AutoimmuneMom.com, written by Gretchen Heber, and first published on Sep 20, 2013.

This post contains the opinions of the author. Autoimmune Association is not a medical practice and does not provide medical advice, diagnosis, or treatment. It is your responsibility to seek diagnosis, treatment, and advice from qualified providers based on your condition and particular circumstances. Autoimmune Association does not endorse nor recommend any products, practices, treatment methods, tests, physicians, service providers, procedures, clinical trials, opinions or information available on this website. Your use of the website is subject to our Privacy Policy.

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