Health Insurance Help
Pre-existing Conditions
Pre-existing conditions are handled differently in each state. In California, individual
medical plans are subject to medical underwriting. The rates reflected in the quotes
you receive from HealthInsurancePlus.com and the insurance carriers are the tier
1 base rates, also referred to as level 1. These are the rates quoted and offered
to healthy individuals applying for coverage. Unfortunately, 'healthy' is a subjective
term. Most carriers use a measurement of an
applicant's BMI or Body Mass Index, also known as your height-to-weight
ratio, among other factors to determine your current level of health. Besides height
and weight, carriers ask for previous and current medical history, medications,
and other questions to determine risk and insurability.
All is not lost if you have a pre-existing condition, many carriers will approve
you at a base rate with an increase of +25% or +50%, and once you have coverage
for a disclosed condition on the application, your medical condition is covered
under the plan and treatable! When you consider the extra health risk your pre-existing
condition represents from a statistical point of view, the increase in extra premium
to cover the condition, and the peace of mind in knowing your condition is covered,
whether it every becomes a bigger problem or not, is usually well worth the extra
premium.
Are there insurable pre-existing conditions?
Some common pre-existing conditions that are still insurable by many carriers include,
breast implants, type two diabetes controlled with diet, recent medical procedures,
such as the appendix being removed, or a c-section delivery. Also, name brand prescriptions
for some conditions, such as anxiety or depression that are expensive may result
in a surcharge of premium.
Talk with your doctor
With pre-existing conditions that appear insurable, medical records will almost
always be requested by the underwriter. Some times it is advisable to confirm with
your physician that there are not any other open medical conditions listed in your
file. For example, you may have mentioned that you had a headache last time you
were in the office, and the doctor may have made a note of it in your file. But
if you did not follow up, and let your doctor know you no longer have the headache,
it may appear as an 'open' condition to the underwriter when reviewing your file.
Also, consider giving your doctors office the 'heads up' that you are shopping for
health insurance. Letting your physician know that your medical file may be requested
soon, can often help avoid delay when the carrier contacts your doctor's office
for a copy of the records.
Return to
Individual & Family