What you need to know about preexisting conditions

The Affordable Care Act (ACA) barred insurance companies from up-charging or refusing to cover those with preexisting conditions.  The restriction, effective since January 2014, was a sharp break from former insurance company practices, when ill applicants were routinely denied or priced out of coverage. Preexisting conditions are, in short, health conditions which exist before the insured’s coverage begins.

List of preexisting conditions

Before the passage of ACA, insurers typically set their own lists of preexisting conditions which either excluded applicants from coverage or significantly drove up the cost of their coverage. Based on those pre-ACA health benefits, the following are examples of preexisting conditions that often served as the basis for applicants’ rate increases in the individual market.

Acne

AIDS/HIV

Alcohol abuse/drug abuse with recent treatment

Alzheimer’s

Anorexia

Asthma

Basal cell carcinoma

C-section

Cancer

Celiac disease

Crohn’s disease

Cerebral palsy

Chronic obstructive pulmonary disease (COPD)/ emphysema

Congestive heart failure

Dementia

Diabetes

Epilepsy

Fibromyalgia

Heart disease

Hemophilia

Hepatitis C

High cholesterol

Inflammatory joint disease

Kidney stones

Migraines

Muscular dystrophy

Obesity

Organ transplant

Paralysis

Parkinson’s disease

Pending hospitalization

Pending surgery

Postpartum depression

Pregnancy

Renal failure

Rheumatoid arthritis

Seasonal affective disorder

Sleep apnea

Stroke

Transsexualism

According to the Kaiser Family Foundation, other conditions like allergies, anxiety, depression, ear infections, fractures, high cholesterol, hypertension, incontinence, menstrual irregularities, restless leg syndrome, tonsillitis, urinary tract infections, varicose veins, and vertigo may make it more difficult to purchase a health insurance plan. And while some pre-ACA plans considered rape and domestic violence to be preexisting conditions, some states have since prohibited that practice. 

See the full text of the 2010 Affordable Care Act.

 References

U.S Department of Health & Human Services, Pre-Existing Conditions (last reviewed Jan. 31, 2017).        

Emily Gee, Number of Americans with Pre-Existing Conditions by Congressional District, Center for American Progress (April 5, 2017).

Alicia Adamczyk, 50 Health Issues That Count as a Pre-existing Condition, Time (May 4, 2017).

Lydia Ramsey, From acne to pregnancy, here’s every ‘preexisting condition’ that could get you denied insurance under Trump’s new healthcare bill, Business Insider (May 5, 2017).

This blog is made for educational purposes and is not intended to be specific legal advice to any particular person. It does not create an attorney-client relationship between our firm and the reader and should not be used as a substitute for competent legal advice from a licensed attorney in your jurisdiction.

© 2017 Jackson LLP

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