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Preexisting Conditions

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New protections for Minnesotans with preexisting conditions

Many Minnesotans have health problems that are considered preexisting conditions if they apply for health insurance or enroll in a new health policy.  A preexisting condition is an illness or injury that existed before a person applies for coverage.

In the past, health insurance carriers have been able to deny Minnesotans coverage due to preexisting conditions.  If a Minnesotan with a preexisting condition is accepted for coverage, the insurance carrier may choose not to cover costs from the preexisting conditions for a period of time after the coverage begins.

The Affordable Care Act eliminates preexisting condition restrictions by 2014 on all employer-based health plans, as well as newer individual health insurance policies

Already, changes have taken place for children.  Kids under age 19 with preexisting conditions cannot be denied access to their parents' health plan and insurance companies can no longer exclude treatments for preexisting conditions of children they insure.

Starting in 2014, this provision will apply to adults as well.

I have been denied coverage because I have a preexisting condition. What will health reform do for me?

Effective January 1, 2014, insurers will be prohibited from discriminating against individuals with preexisting conditions in offering or pricing health insurance policies.

In the meantime, a temporary federal high-risk pool program has been set up in every state, including Minnesota. This temporary federal pool is known as the Preexisting Condition Insurance Plan (PCIP) and provides coverage to U.S. citizens and legal residents with preexisting conditions who have been uninsured for at least six months. Benefit plans offered by the PCIP provide coverage without a preexisting condition exclusion.

The PCIP is operating in addition to our state high-risk pool, the Minnesota Comprehensive Health Association (MCHA). The eligibility requirements for the two pools differ. If you do not qualify for the PCIP plan, MCHA may be an option. MCHA’s website at http://www.mchamn.com/ provides information about eligibility requirements for MCHA, how to qualify for a waiver of MCHA's preexisting condition exclusion, etc.

I have heard that reforms have already been put in place to prevent health plans from excluding preexisting conditions for kids. Is that true?

Yes. Plans already had to make changes to eliminate preexisting condition exclusions for kids under age 19. This change took effect when new plan years started after September 23, 2010.

I have health coverage. After January 1, 2014, will my plan be able to exclude health conditions that I had before I bought my policy?

Most plans will have to eliminate preexisting condition exclusions during 2014. This includes all employer-based group health plans and newer individual health plans. The exact date that the preexisting condition exclusion is eliminated may depend on the start date of the plan or policy year. The change takes effect with the start of the first plan year on or after January 1, 2014.
Policies that were purchased prior to March 23, 2010 to cover one individual or family are an exception. These plans are considered grandfathered and do not have to eliminate restrictions on preexisting conditions. Some of these plans may have riders or other exclusions for their preexisting conditions. 
Minnesotans with grandfathered individual or family plans will have new options with health reform. They would be able to purchase coverage through an Exchange beginning in January 2014 regardless of health condition. 

I have been denied coverage because I have a preexisting condition. What will health reform do for me?

Effective January 1, 2014, insurers will be prohibited from discriminating against individuals with preexisting conditions in offering or pricing health insurance policies. 

In the meantime, a temporary federal high-risk pool program has been set up in every state, including Minnesota. This temporary federal pool is known as the Preexisting Condition Insurance Plan (PCIP) and provides coverage to U.S. citizens and legal residents with preexisting conditions who have been uninsured for at least six months. Benefit plans offered by the PCIP provide coverage without a preexisting condition exclusion. 

The PCIP is operating in addition to our state high-risk pool, the Minnesota Comprehensive Health Association (MCHA). The eligibility requirements for the two pools differ. If you do not qualify for the PCIP plan, MCHA may be an option. MCHA’s website at http://www.mchamn.com/ provides information about eligibility requirements for MCHA, how to qualify for a waiver of MCHA's preexisting condition exclusion, etc.

I have heard that reforms have already been put in place to prevent health plans from excluding preexisting conditions for kids. Is that true?

Yes. Plans already had to make changes to eliminate preexisting condition exclusions for kids under age 19. This change took effect when new plan years started after September 23, 2010.

What about employees under age 19? Can an employee health plan deny preexisting conditions for its employees who are under age 19?

No. Plans cannot deny preexisting conditions for anyone under age 19. This includes employees and dependent children.

If plans cannot exclude preexisting conditions for kids under age 19, can they deny an application for coverage based on a child's health condition?

No. If plans offer coverage to kids under age 19, they must offer coverage to all kids under age 19 regardless of health conditions. If the child is applying for coverage with the rest of the family, coverage can be denied for the entire family because of an adult’s health condition but cannot be denied based on a child’s health condition.

Does this mean that plans are required to offer child-only coverage to new applicants?

No. The Affordable Care Act (ACA) does not require plans to offer child-only coverage.

What plans can I buy now in Minnesota to cover children under age 19?

While health plans in the private market are not offering child-only coverage, all carriers are offering family coverage options. When applying as a family, health conditions of the children cannot be used to deny coverage. If a family is denied coverage based on a parent's health condition, they can apply to the Minnesota Comprehensive Health Association (MCHA). 

The Minnesota Comprehensive Health Association (MCHA) remains available for those looking for child-only coverage.  Applicants looking for child-only coverage can produce a rejection letter from a carrier or agent indicating that no child-only policy is available and use that to apply to MCHA.

Child-only plans are also available through the PCIP program  to kids that have been without coverage for at least six months and that meet the other PCIP plan eligibility requirements. Proof that the child has a preexisting condition is required.

Finally, there are options for covering children under Minnesota Health Care programs. The Minnesota Department of Human Services has information regarding public programs for families with children. Follow this link:  Minnesota Health Care Programs for Families with Children .

A chart summarizing these Coverage Options for Families and Children is posted below under Documents.

I am applying for a family policy. My child has a health condition. Can the company charge me more because of my child’s health condition?

Yes. The company can charge higher rates because of a child’s health condition, though there are limits under Minnesota law.  In Minnesota, plans may charge up to 25 percent more than their base rate due to health conditions at the time of application.

I am becoming a grandparent soon. My grandchild will be living with me. Does health reform have any special provisions for grandchildren? What happens if the baby is born with a health condition?

No. Health reform does not include any requirements related to coverage of grandchildren.

However, if a plan is subject to Minnesota law, there are existing requirements for the coverage of grandchildren. Under Minnesota law, newborn grandchildren who are financially dependent on a covered grandparent and who reside with that covered grandparent continuously from birth must be covered. Newborn grandchildren are covered immediately from the moment of birth and thereafter -- including coverage for illness, injury, congenital malformation or premature birth.  Additional premium payment may be due for the newborn grandchild.

If a person doesn’t know if their plan is subject to Minnesota law, they can ask their human resources department or the company that processes their health claims. If the plan is self-insured, Minnesota’s law does not apply.

I want to change jobs before 2014 and I have a preexisting condition. Will my new employer be able to choose not to cover my preexisting condition?

Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), if a person has been covered for at least a year at their previous job and they enroll in their new employer's health plan without a break of 63 days or more, the new health plan must cover their preexisting condition.

I have health coverage. After January 1, 2014, will my plan be able to exclude health conditions that I had before I bought my policy?

Most plans will have to eliminate preexisting condition exclusions during 2014. This includes all employer-based group health plans and newer individual health plans. The exact date that the preexisting condition exclusion is eliminated may depend on the start date of the plan or policy year. The change takes effect with the start of the first plan year on or after January 1, 2014.

Policies that were purchased prior to March 23, 2010 to cover one individual or family are an exception. These plans are considered grandfathered and do not have to eliminate restrictions on preexisting conditions. Some of these plans may have riders or other exclusions for their preexisting conditions. 

Minnesotans with grandfathered individual or family plans will have new options with health reform. They would be able to purchase coverage through an Exchange beginning in January 2014 regardless of health condition.