What is a pre-existing condition?
A pre-existing condition is usually defined as any medical condition, whether illness or an injury, that required treatment prior to the person taking out health insurance. The specific terms vary among insurance providers -- some include conditions known about only three months before the effective date of coverage, while others exclude coverage of any pre-existing condition for as long as a year after the effective date of coverage. While some providers include only conditions that required treatment, others include any condition the insured knew about, even if it did not require treatment.
How can I get affordable health insurance for my family if I am self-employed?
Several providers have plans designed specifically for self-employed or small-business owners. There are several associations for self-employed or small-business owners through which you can find an affordable plan.
What medical coverage is available for substance abuse?
Most medical insurance providers include substance abuse treatment in their plans, including both in-patient and out-patient programs. However, these plans often require a higher co-insurance percentage -- for example, they may cover only 50 percent as opposed to their normal 80 percent -- and they frequently provide a lower lifetime benefit amount than they do for other medical conditions.
What are out-of-pockets costs that are not covered by major medical plans?
Many major medical plans cover a significant portion of medical expenses, but the insured usually has some expenses they must pay on their own. These expenses usually include co-insurance or co-payment, a cost-sharing method where the provider may pay 80 percent and the insurance 20 percent, for example. Or, there may be a set fee, such as a $10 co-payment for any doctor's office visit. The insured is also responsible for the deductible, a set limit not covered by the provider that the insured must meet before having their costs covered. In addition to these, providers can exclude any expenses they consider beyond "reasonable and customary charges." It is up to the provider to decide what counts as reasonable and customary.
Can I still get health insurance coverage if I'm pregnant?
Under a federal law known as HIPAA, health insurance providers cannot consider pregnancy a pre-existing condition, so you should be able to take out insurance, and file pregnancy-related claims, even after you're already pregnant. However, there are some exceptions: if you have never had health insurance, your new provider may classify your pregnancy as a pre-existing condition; some companies have a one-month waiting period. HIPAA only applies to group health plans, not individual plans. However, there are companies designed specifically for maternity insurance that you can use if you are not eligible anywhere else.
