Regulations re: pre-existing conditions

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Regulations re: pre-existing conditions

I thought the laws had changed and if you did not have health insurance before but became eligible through a company group plan, that pre-existing conditions had to be covered? Is that correct or do I have the terms of this changed?

Asked on May 13, 2009 under Insurance Law, Arizona


MD, Member, California Bar / FreeAdvice Contributing Attorney

Answered 14 years ago | Contributor

It depends on your state and type of coverage.  Here is the main website for the Arizona Dept of Insurance covering health insurance issues:


This is the hyperlink to the Group Health Care handbook:

A portion of the handbook discusses pre-existing conditions and this is what it says:






These provisions limit or exclude the insurance company’s

obligation to pay benefits.



Policies have a list of exclusions

and limitations.



Policies with fewer exclusions may be more

expensive than policies with more exclusions. Make sure you

understand what will and will not be covered.




Waiting Periods

A waiting period is the amount of time that must pass after

the policy takes effect and before coverage begins. If a policy

has a waiting period, benefits will not be paid or they might

be limited for expenses that arise during a specific number of

days after the policy is in effect. Waiting periods are not

applicable in some cases if an individual had certain types of

prior coverage. Waiting periods may apply only to certain

conditions or services.





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.

Waiting Periods, Preexisting Conditions,

Exclusions and Limitations


If you are covered by a group policy provided by your

employer, the waiting period for preexisting conditions cannot

be any longer than 12 months. It may be less or not

applicable at all if you have had previous group coverage.

Do not think that because the application asks no questions

about your health or medical history or the policy requires no

physical examination, the policy will cover conditions that you

already have. It probably will not. If the company asks

questions about your health history it is important to answer

them truthfully.

Under some definitions a condition would be considered

“preexisting” even if you did not know that you had the

condition before you bought your policy. Also, you need to

know how many previous years will be considered for

determining a preexisting condition. A group health plan

provided through your employer cannot look back any further

than six months before your effective date.




Other Exclusions

In addition to preexisting conditions, health insurance policies

usually exclude illness or injury resulting from war or military

service or those covered under workers’ compensation."

IMPORTANT NOTICE: The Answer(s) provided above are for general information only. The attorney providing the answer was not serving as the attorney for the person submitting the question or in any attorney-client relationship with such person. Laws may vary from state to state, and sometimes change. Tiny variations in the facts, or a fact not set forth in a question, often can change a legal outcome or an attorney's conclusion. Although has verified the attorney was admitted to practice law in at least one jurisdiction, he or she may not be authorized to practice law in the jurisdiction referred to in the question, nor is he or she necessarily experienced in the area of the law involved. Unlike the information in the Answer(s) above, upon which you should NOT rely, for personal advice you can rely upon we suggest you retain an attorney to represent you.

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