Contract between my new company and dental plan. My sons orthodontia won’t be covered due to braces already on. Aren’t “preexisting conditions” clauses illegal now?
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Contract between my new company and dental plan. My sons orthodontia won’t be covered due to braces already on. Aren’t “preexisting conditions” clauses illegal now?
I am a new employee. My son has his braces on already & is halfway thru treatment. Contract between my new company & their dental plan irrevocably states that they do not cover orthodontia once the braces are on. How can that be legal? Orthodontia is deemed covered by insurance so it is standard healthcare and therefore not “cosmetic” how can this be done? They do this by utilizing the “pre-existing” clause that is no longer allowable for insurance plans to use to get out of paying for people’s health care & have offered it as an option for the company in which they took. What are my options?Thank U
Asked on June 28, 2009 under Insurance Law, Arizona
Answers:
MD, Member, California Bar / FreeAdvice Contributing Attorney
Answered 14 years ago | Contributor
No pre-existing clauses are not generally illegal or against the law. The quote below is from the following insurance consumer guide to health insurance in your state: http://www.id.state.az.us/publications/Health_Group.pdf
Preexisting Conditions Individual policies usually will not pay benefits until a certain time period has elapsed for a health condition you had when you bought the policy. This type of health condition is known as a “preexisting” condition. Exclusions for preexisting conditions are intended to preclude individuals with an illness or injury from waiting to buy a policy until they need treatment that would otherwise be paid for under the policy. You should know the meaning of any provisions excluding benefits for preexisting conditions. Also, you should know how long the provision will exclude benefits for preexisting conditions. Many claims are denied because of these provisions.
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