How Will Preexisting Conditions Affect Your Health Insurance Coverage?

If you have preexisting conditions when you are looking for NC health insurance, one of three outcomes are likely to happen. You will either (1) be declined for coverage, (2) have your condition ridered, or (3) your premium will be increased. In this article we will look at how most carriers will handle common preexisting conditions.

When people talk about NC health insurance and preexisting conditions, what they are talking about is getting coverage for conditions that you may have prior to getting the coverage. This could include chronic illness, mental illness, or hereditary illness. Each carrier will handle conditions differently and it really depends on what the condition is. For example, if you have had a heart attack, cancer, stroke or diabetes you likely will likely be declined coverage by all carriers of individual plans. Other common conditions that will lead to a decline are rhemoatoid arthritis, heart disorders, fibromyalgia, severe mental disorders, COPD, and cystic fibrosis. This is just a small sample of common but typically expensive conditions that will make you ineligible for individual coverage.

Another measure carriers do to control costs is by ridering (or excluding) the medical condition all together. When this occurs they will not cover any treatment, including prescription drugs, for the amount of time the condition is ridered. This is commonly done for conditions when treated with medication like asthma, gout, depression/anxiety and osteoperosis.

Some carriers may just increase your premium to cover the increased risk or costs that are associated with your condition. Common conditions for this are high blood pressure or high cholesterol. These types of conditions can still lead to a rejection by the carrier (depending on other risk factors) but likely you will see an increased premium level. The reason carriers do this is because they are taking increased risks that these conditions may lead into serious and expensive health conditions like a heart attack or stroke.

For people with serious health conditions or are on a multitude of prescription drugs, your best bet will likely be to obtain group coverage through an employer. If group coverage is not an option then you may qualify for the North Carolina high risk pool. This plan is a state issued plan that is guaranteed issue if you meet the qualifying factors and is designed for people with health issues. As long as you have not had a lapse of coverage of more than 63 days, your preexisting conditions will be covered by both of these options.

It's also important to note that if you have a preexisting condition and have been without health coverage for more than 63 days, if approved for coverage most carriers will automatically exclude the condition for the first 12 months the policy is in effect. This is why it is very important to have continuous coverage.

As you can see, if you have a preexisting health condition, finding the right coverage can be complicated. To get started, especially if you are clueless about insurance terminology and how carriers will handle preexisting conditions, you may want to enlist the help of an insurance agent who knows the particular ins and outs of NC health insurance carriers.