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


MD, Member, California Bar / FreeAdvice Contributing Attorney

Answered 11 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:

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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