What is considered to be a pre-existing condition for the purposes of obtaining new health insurance?

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What is considered to be a pre-existing condition for the purposes of obtaining new health insurance?

From my old job, I had insurance for 5 years until 6 months ago. I started new job at that time. They have a “3-month waiting period” for new hire to be eligible for health insurance. I was enrolled beginning 2 months ago. Unfortunately, during the waiting period, I was diagnosed with cancer. Is this considered a pre-existing condition? Under HIPPA guidelines, it states that the waiting period is not to be considered as a significant break in coverage? Will this apply to me as I did not have a significant break (more than 63 days) because it was under the 3-month waiting period?

Asked on August 5, 2011 New York

Answers:

MD, Member, California Bar / FreeAdvice Contributing Attorney

Answered 10 years ago | Contributor

Your pre-existing condition arguably should have been at the time of application and not during the waiting period. The 3 month waiting period seems like it doesn't meet guidelines so check in with your state's insurance agency that regulates health insurance and also before you do, wait to see what the decision is on insurance coverage. You should not be denied coverage because you were not diagnosed (usually the sign of pre-existing condition) until after you applied. Do not panic yet. But start to research lawyers who have experience with regulation and lawsuits against insurance companies for bad faith coverage or failure to cover. Then, review your prior insurance and look into COBRA and see what those provisions state.


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