Believe it or not, health insurance is a business. Unfortunately, in some cases, company profit is put ahead of an individual's well-being.

Such is the case with pre-existing health conditions. A pre-existing condition is a medical condition that was diagnosed or treated prior to applying for health insurance. For instance, many people with heart disease, cancer, diabetes, etc., have been denied health coverage because a provider viewed them as a financial liability.

HIPAA and Pre-existing Health Conditions

HIPAA legislation went into affect in 1997. These laws changed the way in which health insurers must treat pre-existing conditions.

Prior to this, if you started a new job, you could be denied coverage due to pre-existing conditions. Alternatively, you might have been offered coverage at a higher rate or had coverage for your condition excluded from the policy. An exclusion means that you would not receive coverage for your pre-existing condition for a specified period of time, and would have to pay these costs out-of-pocket.

HIPAA reduced the ability of insurers to exclude pre-existing conditions. Now, if you've had ‘credible coverage' (standard indemnity, managed care, individual or group coverage) for 12 months or longer, when you change jobs, your pre-existing condition will be covered by your new insurance. The new insurer cannot exclude your pre-existing condition or enforce a waiting period. You will be covered immediately.

But if you have a pre-existing condition, you still have to be careful. If haven't been insured for longer than one year, or you take a break from coverage for more than 63 days, say while you're between jobs, you will be subjected to pre-existing condition exclusions when you start a new policy. To avoid a 63 day break, utilize COBRA benefits.

Pre-existing condition exclusion can not be applied to pregnant women, newborns, or adopted children under the age of 18.

Getting Coverage

If you have a pre-existing condition and are not insured, the best way for you to get it is through group coverage. Under HIPAA, and many state laws, you cannot be denied group coverage for pre-existing conditions.

If you attempt to get an individual policy, you will be required to report on your medical history. With a pre-existing condition, you may be denied individual coverage. In other cases, you may be offered coverage at higher rates, with exclusions, or with waiting periods. The better bet is to find group coverage.

You can find group coverage through employers, professional associations, alumni groups, local Chambers of Commerce, buying groups and risk pools.

Risk pools are currently available in 33 states. Risk pools are created by state legislatures to help individuals who have been denied coverage due pre-existing health conditions to find coverage. Their cost, and the coverage they offer, varies greatly from state to state.