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View Full Version : About person health insurance and the "does not cover pre-existing conditions" HELP!


Natalie00
12-09-2005, 06:22 PM
I am losing my parents health care in about 6 months, and I am looking into personal health insurance. However, what exactly does it mean when it says "does not cover pre existing conditions"? First, let me say that I am unable to work due to Chronic Fatigue Syndrome, but my getting disability is unlikely due to the fact that I am young and before I got CFS I had very little work experience (1 year) and then I was in school. I would also like to explore medicare (or cade?) if anyone has any info on those programs.

CFS shoudn't really even count as a "condition" and I won't even report it if I apply for personal healthcare because there is no medication I take for it (no medication exists to treat CFS) and there is nothing that can be done for it, so it's not like I need treatmet for CFS.
I do have asthma and need an inhaler, as well as nexium. I also take a generic medication (calcium channel blocker for Mitral valve prolapse which is a benign condition but I take the medication for the annoying PVC's I get) and a sleep medication (also generic).
I know that birth control pills won't be covered but I can always go to planned parenthood for that.

Any advice?? Will I be approved? I want to figure out my plan within next couple months so I will be prepared.
Thanks!
Natalie

Natalie00
12-11-2005, 05:52 PM
Anyone have any advice??

madera74
12-13-2005, 06:23 PM
Generally on individual insurance plans, one of the following will happen regarding your pre-ex conditions:
1) an exclusion rider may be applied, so you will be issued a policy but it will not cover anything pertaining to that condition (may or may not exclude Rx medications)
2) you may receive a rate increase to your monthly premium, but the pre-ex condition will be covered
3) you may be declined coverage due to risk
4) or on certain conditions they may take no action, and offer you coverage for that condition without limitations

Likely you will be asked in a certain timeframe (such as the past 10 years) if you have had symptoms or medical treatment for any conditions, taken any medications, had hospital stays, ER visits, etc. You should be forthcoming with all answers, because the underwriters could potentially order your medical records or claims history (if you're applying for an indiv. policy through the same company where you have group coverage), and it's common to run a MIB (Medical Information Bureau) query on all applicants, which shows what type of claims have been submitted for that person. So, if you have ever seen a physician for the chronic fatigue, for example, it will probably come up whether you disclose it or not. Also, if you fail to disclose something and it comes up later and any claims are investigated, you could lose your policy altogether.

Birth control pills may or may not be covered, depending on the carrier. Some plans will decline you if you require x number of exclusion riders or take x number of medications or things like that, but again it varies by carrier. You probably won't be able to start applying for coverage until a month or so before you want it to start, but it wouldn't hurt to start talking to an agent (there is no cost to you to use an agent in finding coverage) who is familiar with the insurance carriers in your area and their underwriting guidelines and who might know what kind of offer you should expect. If you find a good agent to work with, that person can help you shop around for the best plan for you. Good luck!

Natalie00
12-13-2005, 07:00 PM
Thanks so much for the reply, you have been very helpful!

What is my alternative to personal health insurance?? I am unable to work due to my CFS, in fact I have had to drop out of school. I am "disabled" but there is about zero chance I will get disability. What kind of government sponspored health care program will I be eligible for??

Thanks!

madera74
12-14-2005, 09:16 PM
You might be eligible for Medicaid, which is income-based. Do a search for Medicaid and you will find the government website which has a good deal of information.

 
 
 




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