Pre-Existing-Conditions

Only available on StudyMode
  • Download(s) : 320
  • Published : October 25, 2011
Open Document
Text Preview
Pre-Existing Conditions

By

Submitted to the Division of Graduate Studies
in partial fulfillment of the requirements for
MBA 512: Health Policy and Law

Shepherd University

April 13, 2010

Abstract

Imagine paying $500, $600, $700, or $1,000 monthly for health care insurance only to realize these payments were for naught. The health care insurance provider that received these monthly installments has decided whatever is ailing you will not be covered due to a pre-existing medical condition. What if you couldn’t have the luxury of health care insurance at all due to the basis the health care insurance provider has concluded you have a pre-existing medical condition? These are the dilemmas facing millions of Americans today in the current health care system. America’s health insurance companies exist to make a profit and not for the general well being of the persons they insure. To achieve a profit the health insurance companies must deny coverage claims when Americans need coverage the most or not cover these individuals in the first place. This is a problem that the United States is addressing, or trying to address, in heated debate on Capitol Hill. Many of our Republican politicians want to continue with the status quo of the health care system while Democrats seek to eliminate pre-existing conditions altogether. The American public has come to recognize there has to be a major overhaul of the current health care system starting with pre-existing conditions.

Pre-Existing Conditions Defined

The University of Pittsburg Medical Center defines a pre-existing condition as (University of Pittsburg Medical Center, 2011), “A medical condition that occurred before a program of health benefits went into effect”. The Henry J. Kaiser Family Foundation (Kaiser Family Foundation, 2011) breaks down further what exactly the definitions for health insurance companies are varied by state. Their define the breakdown as “some states use an objective standard allowing only those conditions for which someone actually received medical advice, diagnosis, care or treatment prior to enrollment to be counted as pre-existing. Most states use a broader, prudent person standard, which also includes conditions that were never diagnosed, but which exhibited symptoms for which an ordinary prudent person would have sought medical advice, care or treatment”. The Kaiser Family Foundation’s market portability rules (Kaiser Family Foundation, 2011) has listed 21 states that require health insurance companies to use the prudent person standard, 18 states require the objective standard, while 10 states have no definition specification. Listed below are the state laws for group and individual insurance plans. These laws are broken down into large, small and group insurance plans. Each group has the allotted amount of time a state can look back for a pre-existing condition from the start date of the policy and how long a pre-existing condition can be excluded by the policy given by The Kaiser Family Foundation market profitability rules by state (2011, 1). Maximum pre-existing condition exclusion period group plans

Small Group Plans with 2 – 50 employees: Large Group Plans: 0 Months - Hawaii, Maryland, Michigan 12 months - 50 states and DC 3 Months - Kansas

6 Months - California, Colorado, New Jersey,
Massachusetts, New Mexico,
Oregon, Rhode Island
9 Months - Indiana
12 Months – 36 remaining states and DC

Maximum pre-existing condition look back period group plans
Small Group Plans with 2- 50 employees: Large Group Plans:
0 Months - Hawaii, Maryland, Michigan 6 Months - 50 states and DC
6 Months - Kansas, New Hampshire

Maximum pre-existing condition exclusion period individual plans 0 Months - Massachusetts, Oregon, New Mexico
9 Months - New Hampshire, Washington
12 Months - California,...
tracking img