120:
1129:, has stated that "insurance companies want premiums without any risk" and go to extreme "lengths... to go to make a profit". InsureMe, an insurance quote provider website, has argued that even though health insurance is basically to protect people from very high costs of health care, the commercial health insurance system is not playing fair and are always trying to avoid risk in order to boost their profits.
32:
73:
1174:, has voted to allow insurance companies to consider domestic violence as a pre-existing condition and supported his vote by saying that covering such people could raise insurance premiums to the point where it would preclude others from buying it. He has remarked that "If you have no insurance, it doesn't matter what services are mandated by the state".
1482:"Patient Protection and Affordable Care Act; Requirements for Group Health Plans and Health Insurance Issuers Under the Patient Protection and Affordable Care Act Relating to Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, and Patient Protections; Final Rule and Proposed Rule"
267:
Most insurance companies use one of two definitions to identify such conditions. Under the "objective standard" definition, a pre-existing condition is any condition for which the patient has already received medical advice or treatment prior to enrollment in a new medical insurance plan. Under the
272:
Which definition may be used was sometimes regulated by state laws. Some states required insurance companies to use the objective standard, while others required the prudent person standard. 10 states did not specify either definition, 21 required the "prudent person" standard, and 18 required the
1294:
The public's most unanimous and bipartisan support is saved for a proposal to have the federal government require that health insurance companies cover anyone who applies, even if he/she has a pre-existing condition. Overall, eight in ten back the proposal, including 67 percent of
Republicans, 80
1256:
in
September 2010 stated, "Health care should be accessible for all, regardless of pre-existing conditions or past illnesses.... We will make it illegal for an insurance company to deny coverage to someone with prior coverage on the basis of a pre-existing condition." In a March 3, 2010, address,
1124:
spokeswoman K.C. Eynatten has said, "We realized our position was based on gut feelings, not hard numbers... we became aware that we were part of the reason a woman and her children might not leave an abuser. They were afraid they'd lose their insurance. And we wanted no part of that." Jerry
1151:
The rationale behind pre-existing condition clauses, according to those who defend the policies, is that they reduce the cost of health insurance coverage for those who still receive it, thus giving more people an opportunity to afford insurance in the first place. The
396:
of 1974 (ERISA) which exempted self-insured large group health insurance plans from state regulation. After most states had by the early 1990s implemented some limits on pre-existing condition exclusions by small group (2 to 50 employees) health insurance plans, the
1111:
from excluding maternity coverage for a pre-existing condition of pregnancy; this prohibition was extended to all group health insurance plans by the Health
Insurance Portability and Accountability Act of 1996 (HIPAA).
1158:
has reported that "osts for those with coverage could go up because people in poor health who'd been shut out of the insurance pool would now be included... they would get medical care they could not access before."
1100:
Pre-existing condition exclusions were prohibited for HIPAA-eligible individuals (those with 18 months continuous coverage unbroken for no more than 63 days and coming from a group health insurance plan).
413:
group health insurance plans—including the self-insured large group health insurance plans that cover half of those with employer-provided health insurance but are exempt from state insurance regulation.
1283:-Abt SRBI poll in late July 2009 found that a large majority of Americans (80%) favored a requirement that insurance companies insure people even if they have pre-existing conditions.
398:
130:
1324:
1261:
said that coverage denied to those with pre-existing conditions is a serious problem that would only grow worse without major reforms. In a
September 2010 visit with
1996:
1434:
276:
According to the Kaiser Family
Foundation, more than a quarter of adults below the age of 65 (approximately 52 million people) had pre-existing conditions in 2016.
2287:
242:
defines a pre-existing condition as a "medical condition that occurred before a program of health benefits went into effect". J. James Rohack, president of the
268:
broader, "prudent person" definition, a pre-existing condition is anything for which symptoms were present and a prudent person would have sought treatment.
2226:
2267:
285:
220:
253:
94:
81:
1572:
2062:
2034:
1328:
393:
239:
45:
423:
Maximum pre-existing condition exclusion period (states that permitted elimination riders permanently excluding pre-existing conditions noted by
2004:
1565:
1305:
1141:
380:
Regulation of pre-existing condition exclusions in individual (non-group) and small group (2 to 50 employees) health insurance plans in the
2302:
1849:
1823:
1797:
211:
went into effect. Before 2014, some insurance policies would not cover expenses due to pre-existing conditions. These exclusions by the
182:
164:
59:
1459:
2161:
2246:
2120:
1360:
196:
1253:
1332:
230:, more than a quarter of adults below the age of 65 (approximately 52 million people) had pre-existing conditions in 2016.
2008:
1969:
1145:
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Individual (non-group) health insurance plans could exclude maternity coverage for a pre-existing condition of pregnancy.
1965:
2143:
1914:
243:
2268:"Trump to sign executive orders protecting preexisting conditions and seeking a way to prevent surprise medical bills"
142:
51:
296:
National high-risk pool for individuals with a pre-existing condition who have been uninsured for the prior 6 months
146:
1883:
389:
86:
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803:
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20:
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402:
2227:"Fact check: Trump claims GOP is protecting people with pre-existing conditions. Evidence says otherwise"
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Advocates against pre-existing condition rules argue that they cruelly deny people in need of treatment.
1386:
1646:"A different kind of 'new federalism'? The Health Insurance Portability and Accountability Act of 1996"
1364:
1269:
as personal examples in the audience of those benefiting from changing pre-existing condition rules.
1160:
1107:
Group health insurance plans sponsored by employers with 15 or more employees were prohibited by the
926:
573:
2091:
1919:
1888:
1181:, other possible situations falling under pre-existing condition clauses are chronic conditions as
1798:"Individual market portability rules (not applicable to HIPAA eligible individuals), January 2010"
369:
existing health insurance plans must prohibit pre-existing condition exclusions by
January 1, 2014
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366:
318:
212:
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Premium for older individuals allowed to be up to 4 times the premium for younger individuals
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208:
1645:
409:
Act) of 1996 (HIPAA) extended some minimal limits on pre-existing condition exclusions for
219:
by potential customers. Such exclusions have been prohibited since
January 1, 2014, by the
1850:"Small group health insurance market pre-existing condition exclusion rules, January 2010"
1696:
1279:
248:
1566:"Public Law 104-191. Health Insurance Portability and Accountability Act of 1996 (HIPAA)"
305:
Premium for tobacco users allowed to be up to 1.5 times the premium for non-tobacco users
1140:
to be an excludable pre-existing condition, have been called abuses by Maria
Tchijov, a
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1602:
1522:
1245:
1206:
1190:
950:
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259:
Conditions can be broken down into two further categories, according to Lisa Smith of
2281:
1695:
Pollitz, Karen; Tapay, Nicole; Hadley, Elizabeth; Specht, Jalena (July–August 2000).
1218:
1066:
1030:
1004:
871:
759:
745:
692:
546:
453:
431:
381:
19:
This article is about the term in health insurance. For medical use of the term, see
1481:
1412:"Individual Market Portability Rules (Not Applicable to HIPAA Eligible Individuals)"
1390:
1258:
1020:
904:
881:
849:
787:
534:
530:
526:
518:
260:
2194:"Kaiser Health Tracking Poll—September 2009: Public opinion on health care issues"
2193:
1942:
16:
Medical condition that started before a person's health benefits went into effect
1222:
1210:
1198:
1186:
841:
821:
506:
498:
406:
1973:
252:
interview that exclusions, based upon these conditions, function as a form of "
1265:, residents, Obama referred to a woman with an eye condition and a woman with
1214:
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481:
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440:
385:
1768:
1615:
1535:
1666:
1564:
Kassebaum, Nancy Landon; Kennedy, Edward M.; et al. (August 21, 1996).
1226:
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1163:
958:
954:
829:
767:
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645:
601:
593:
558:
1776:
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1717:
72:
2247:"Democrats Unite to Begin Push to Protect Pre-Existing Condition Coverage"
1674:
1623:
1543:
312:
Immediate reform: effective
September 23, 2010 (6 months after enactment)
2230:
1595:"The politics of the Health Insurance Portability and Accountability Act"
1513:
Gabel, Jon; Liston, Derek; Jensen, Gail; Marsteller, Jill (Spring 1994).
1230:
1056:
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1000:
984:
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684:
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577:
542:
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494:
477:
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1966:"Rural health response to domestic violence: policy and practice issues"
1435:"FACT CHECK: Who's Right About Protections For Pre-Existing Conditions?"
1824:"Non-group coverage rules for HIPAA eligible individuals, January 2010"
1697:"Early experience with 'new federalism' in health insurance regulation"
1171:
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888:
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680:
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569:
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510:
489:
1746:
Gabel, Jon R.; Jensen, Gail A.; Hawkins, Samantha (March–April 2009).
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Pre-existing condition exclusions prohibited for children under age 19
1202:
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990:
976:
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712:
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585:
435:
2266:
Lovelace, Berkeley Jr. & Breuninger, Kevin (September 24 2020).
293:
Immediate reform: effective June 21, 2010 (90 days after enactment)
392:
of 1945 which delegated insurance regulation to the states and the
908:
833:
751:
688:
676:
597:
473:
465:
1884:"When getting beaten by your husband is a pre-existing condition"
668:
Elimination riders permanently excluding pre-existing conditions
2271:
1748:"Self-insurance in times of growing and retreating managed care"
1182:
900:
799:
791:
581:
538:
522:
2061:
Alonso-Zaldivar, Ricardo; Tompson, Trevor (November 17, 2009).
1460:"Side-by-side comparison of major health care reform proposals"
1295:
percent of political independents and 88 percent of
Democrats.
1480:
U.S. Department of Health and Human Services (June 28, 2010).
299:
Premium to be set at a standard rate for a standard population
113:
66:
25:
2033:
Ricardo Alonso-Zaldivar; Trevor Tompson (November 17, 2009).
129:
deal primarily with the United States and do not represent a
1515:"The health insurance picture in 1993: some rare good news"
2142:
Aizenman, N. C.; Kornblut, Anne E. (September 23, 2010).
2162:"Time magazine/Abt SRBI — July 27–28, 2009 survey"
138:
1593:
Atchkinson, Brian K.; Fox, Daniel M. (May–June 1997).
1387:"Health insurance: paying for pre-existing conditions"
967:
Small group (2 to 50 employees) health insurance plans
333:
Reform delayed for 4 years: effective January 1, 2014
2090:
Suderman, Peter (opinion blog) (September 23, 2010).
1644:
Nichols, Len M.; Blumberg, Linda J. (May–June 1998).
1361:"Pregnancy a 'pre-existing condition'? Yes, for some"
1091:
Maximum look-back period for pre-existing conditions
1044:
Maximum look-back period for pre-existing conditions
741:
Maximum look-back period for pre-existing conditions
2092:"What the GOP's Pledge has in common with ObamaCare"
399:
Health Insurance Portability and Accountability Act
1997:"Domestic violence is a 'pre-existing condition'?"
1177:According to the California-based advocacy group
1078:Large group (self-insured) health insurance plans
1915:"Acne, pregnancy among disqualifying conditions"
1083:Maximum pre-existing condition exclusion period
972:Maximum pre-existing condition exclusion period
343:Pre-existing condition exclusions prohibited in
2167:. New York: SRBI. July 29, 2009. Archived from
1292:
265:
2121:"Text of President Obama's health-care speech"
2063:"Americans fear health law's costs poll finds"
2035:"Americans fear health law's costs poll finds"
1908:
1906:
418:Individual (non-group) health insurance plans
127:The examples and perspective in this article
8:
2028:
2026:
1913:Hilzenrath, David S. (September 19, 2009).
60:Learn how and when to remove these messages
1354:
1352:
1350:
286:Patient Protection and Affordable Care Act
221:Patient Protection and Affordable Care Act
1125:Flanagan, health-care policy director of
361:health insurance plans limited to 90 days
183:Learn how and when to remove this message
165:Learn how and when to remove this message
2144:"Obama returns to stump for health care"
97:of all important aspects of the article.
1877:
1875:
1873:
1871:
1329:University of Pittsburgh Medical Center
1316:
394:Employee Retirement Income Security Act
288:(Pub.L. 111–148) enacted March 23, 2010
240:University of Pittsburgh Medical Center
1964:Johnson, Rhonda M. (August 30, 2000).
1943:"Health insurance tricks to beware of"
93:Please consider expanding the lead to
2288:Health insurance in the United States
2005:Service Employees International Union
1995:Tchijov, Maria (September 11, 2009).
1306:Pre-existing Condition Insurance Plan
1248:opinion blog by Peter Suderman, the '
1142:Service Employees International Union
7:
1109:Pregnancy Discrimination Act of 1978
1359:Jacobson, Louis (August 18, 2009).
2225:Timm, Jane C. (October 23, 2018).
1882:Grim, Brian (September 14, 2009).
323:individual health insurance plans
14:
2245:Pear, Robert (February 6, 2019).
2071:. Associated Press). p. A118
1433:Julie Rovner (October 11, 2018).
1385:Smith, Lisa (February 16, 2009).
1144:new media coordinator, and by an
357:Waiting period for enrollment in
315:Group health insurance plans and
41:This article has multiple issues.
1205:, hazardous occupations such as
118:
71:
30:
1286:In September 2009, the monthly
1136:companies, such as determining
1039:12 months: 36 other states + DC
280:Current U.S. federal regulation
207:that started before a person's
197:healthcare in the United States
85:may be too short to adequately
49:or discuss these issues on the
1071:6 months: 45 other states + DC
95:provide an accessible overview
1:
1970:Office of Rural Health Policy
1146:Office of Rural Health Policy
340:group health insurance plans
1945:. allinsuranceinfo.org. 2007
1331:(UPMC). 2010. Archived from
244:American Medical Association
2303:Social problems in medicine
1288:Kaiser Health Tracking Poll
354:as a pre-existing condition
141:, discuss the issue on the
2321:
1573:Government Printing Office
350:Prohibit treating acts of
18:
1086:12 months: 50 states + DC
2201:Kaiser Family Foundation
1854:Kaiser Family Foundation
1828:Kaiser Family Foundation
1802:Kaiser Family Foundation
1769:10.1377/hlthaff.22.2.202
1616:10.1377/hlthaff.16.3.146
1536:10.1377/hlthaff.13.1.327
1467:Kaiser Family Foundation
1094:6 months: 50 states + DC
228:Kaiser Family Foundation
215:were meant to cope with
2068:San Francisco Chronicle
2040:San Francisco Chronicle
1667:10.1377/hlthaff.17.3.25
1237:Commentary by lawmakers
1155:San Francisco Chronicle
1132:Some practices by some
384:was left to individual
21:Complication (medicine)
1718:10.1377/hlthaff.19.4.7
1297:
1267:non-Hodgkin's lymphoma
1263:Falls Church, Virginia
1231:the intention to adopt
347:health insurance plans
273:"objective" standard.
270:
201:pre-existing condition
2011:on September 16, 2009
1325:"Billing terminology"
726:permitted*: 37 other
390:McCarran–Ferguson Act
2203:. September 29, 2009
2199:. Washington, D.C.:
1968:. Washington, D.C.:
1852:. Washington, D.C.:
1826:. Washington, D.C.:
1800:. Washington, D.C.:
1571:. Washington, D.C.:
923:District of Columbia
642:District of Columbia
147:create a new article
139:improve this article
2174:on January 16, 2011
2148:The Washington Post
1920:The Washington Post
1889:The Huffington Post
1116:Practice and effect
388:as a result of the
2252:The New York Times
1494:(123): 37187–37241
1465:. Washington, DC:
1335:on October 3, 2010
256:" of health care.
246:, has stated on a
213:insurance industry
195:In the context of
1976:on April 25, 2009
1469:. March 22, 2010.
1250:Pledge to America
1179:Consumer Watchdog
1138:domestic violence
1127:Consumer Watchdog
376:Former regulation
352:domestic violence
226:According to the
217:adverse selection
205:medical condition
193:
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185:
175:
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149:, as appropriate.
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2020:
2018:
2016:
2007:. Archived from
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1972:. Archived from
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1487:Federal Register
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1254:Republican Party
1252:' issued by the
1134:health insurance
209:health insurance
188:
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2219:Further reading
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2123:. March 3, 2010
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1414:. July 21, 2014
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1241:According to a
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427:and asterisk*)
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249:Fox News Sunday
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1956:
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1902:
1867:
1856:. January 2010
1841:
1830:. January 2010
1815:
1804:. January 2010
1789:
1763:(2): 202–210.
1756:Health Affairs
1738:
1705:Health Affairs
1687:
1654:Health Affairs
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1610:(3): 146–150.
1603:Health Affairs
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1530:(1): 327–336.
1523:Health Affairs
1505:
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1365:PolitiFact.com
1346:
1327:. Pittsburgh:
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1273:Public opinion
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1191:toenail fungus
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951:South Carolina
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590:South Carolina
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515:North Carolina
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317:new (non-
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1498:July 26,
1418:March 8,
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