Insurance companies try to discourage people from waiting until they get sick in order to purchase health insurance. One way in which they do this is to impose pre-existing condition exclusion periods. This means that if you have a medical problem which exists at the time you enroll in or purchase your health insurance, the insurance company will deny all claims pertaining to this medical problem for a certain period of time.
If you have job-based coverage, the pre-existing condition exclusion period is limited to 12 months (18 months if you are a late enrollee) and only applies to conditions for which you sought treatment in the 6 months leading up to enrollment. You may be able to apply creditable coverage to offset your pre-existing condition exclusion period. For example, if you were on an individual policy before enrolling in your job-based coverage, you may be able to subtract the amount of time you were covered on your individual policy from the pre-existing condition exclusion period.
The rules governing pre-existing condition exclusion periods in individual policies vary widely from state to state. As a general rule, they are very different from the rules limiting pre-existing condition exclusion periods in job-based coverage. Check out these consumer guides which contain state-specific information about pre-existing condition exclusion periods in individual policies.
