What is an exclusionary period?
The exclusionary period allowed on an individual health plan may differ from that permitted on group health plans. This is clearly defined by state insurance regulations. For instance, Florida health insurance regulations allow for insurance companies to impose a 24 month exclusionary period on individual health plans, but it is only 12 months on employer-sponsored group health plans. Since the exclusionary period is directly related to the look-back period, they are often the same length of time. It is the look-back period that regulates how far back in an insured member’s health history they can look to determine if a claim is related to a pre-existing medical condition. Some states do not allow insurance companies to impose an exclusionary period, while other states place no restrictions on the length of time for these exclusions. For persons that are transferring from a group health plan to an individual health plan under federal HIPAA eligibility, the insurance companies may not place an exclusionary period on the new policy. In some states, the insurance companies can’t place an exclusion on HMO plans, but they can on all other types of medical insurance plans. To determine if they plan you are applying for has an exclusionary period for pre-existing medical conditions, refer to the plan brochure or ask the insurance company. 1 CommentLeave a comment |
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What is an exclusionary period?
On many different types of medical insurance coverage, the insurance companies are exempt from paying claims on any treatment related to a pre-existing medical condition. This exemption is usually set for a certain number of months from the date the policy became effective and is most commonly set at 12 months. This set period of time is referred to as the pre-existing condition exclusionary period. Unlike an elimination rider, all pre-existing medical conditions can be affected by the exclusionary period. Under the exclusionary period clause, the insurance companies may deny paying benefits on any pre-existing medical condition, even if that condition was not included in an elimination rider. However, if the condition is not included in an elimination rider clause on an individual’s policy, then the insurance company must begin providing coverage for the problem after the exclusionary period is over. The allowable length of exclusionary periods are determined by state legislation and can vary based on type of health insurance and other factors.
How are the HMO health insurance plans in California different than similar PPO health insurance plans when it comes to preexisting conditions. Here is the thing. I have a new employer and they had a choice of several health plans one being HMO. They also had an attractive offer of a PPO plan, but I couldn’t afford that, so in the end I stuck with the HMO plan. Well, since it has been some time since my last job I understand that I will currently not be exempt for preexisting conditions based on previous employment. The website for the PPO plan said that the category that I fall under will not be covered for preexisting conditions for the first 6 months, but the HMO had nothing in writing about this. Is there are difference between these two? Does HMO’s have to cover you immediately?
Comment by Ross — June 22, 2009 @ 12:08 pm