Pre-existing Medical Conditions

A pre-existing condition is a medical condition diagnosed or treated before applying for a new health plan. In the past, health care given for pre-existing conditions often were not covered for someone joining a new plan, until after a waiting period. However, a new law—called the Health Insurance Portability and Accountability Act—changed the rule in 1997.

California Individual Health Insurance

In California if you are applying for individual health insurance you must be healthy. Insurance companies do not have to accept you if you have a major pre-existing condition. If you are taking more than 3 medications or you recently had a major medical procedure you may not qualify for a regular individual plan.

If your pre-existing condition is not major you may get approved with a higher premium rate. It is important to know that different insurance companies have different underwriting guidelines. You may be eligible with one company and declined by another.

If you are not sure whether you will be qualified or not, please contact us with information regarding your condition, age, gender ... and we will let you know which insurance carrier is most likely to give you an approval and we will give you a few suggestions about your options.

California Group Health Insurance

Pre-existing conditions of an applicant for small group health insurance plays a very small role, if at all. Group policies are underwritten as a group and are not based on each individual employee. Therefore, companies cannot increase the rate or reject an individual employee or dependent based on their health or physique. However, they can increase the rate for the entire group by 10% if it is justified.