Preexisting Condition Basics

How are preexisting conditions handled under healthcare reform?

Guaranteed issue—requiring insurers to take all applicants, including people with preexisting conditions—will eventually apply to everyone. Effective immediately, preexisting condition exclusions are no longer allowed for children. For adults, the ban takes effect in 2014.

How does the change in preexisting condition exclusions affect the coverage I offer my employees?

If you currently offer coverage, there is no change now in how preexisting conditions are handled, except for children: Since September 2010, preexisting condition exclusions have been prohibited for children.

Beginning in 2014, qualified health plans will no longer be able to deny coverage or charge a different premium based on preexisting conditions, health status or claims history.

Will waiting periods still be allowed?

Effective January 1, 2014, waiting periods for group coverage will be limited to no more than 90 days. Waiting periods don’t apply to the individual market.