subject: Group Health Insurance And Exclusions [print this page] Group Health Insurance And Exclusions
Getting insured is very important, however, it is has raised a lot of debate since it was introduced. Some people think that when someone has pre-existing medical conditions, then they are not eligible for group health insurance. The truth is that the cover does not exclude people on the basis of their present condition. Even people with disabilities are allowed to apply for it. This is to ensure that no one is left out just because they are suffering from a condition they did not impose on themselves.
In the past, most companies provided cover and excluded people based on their past medical history. Though this may not be the case today, insurers and employers are still entitled to enquire if an employee is suffering from any medical condition. Before an employee is given cover, the company goes through their medical history thoroughly. Any employee who submits their claims within the first year of cover also must be thoroughly checked.
The insurer will look back at the claimant's medical history to establish if there exists or existed any medical condition that warrants attention. In case the insurer discovers that there existed a medical condition, they must not refuse to give the employee cover. What the insurer does is to exclude the employee coverage for the pre-existing medical conditions.
There are laws in that control the extent of exclusions that employers and insurers should include in their plans. For example, the law does not allow one to make exclusions based on pregnancy or any genetic disorder. The exclusions are also not permitted for adopted children or those to be adopted or new born.
In most cases, the period of exclusion for pre-existing medical situations is only obligated only after six months elapses after joining the company. This will only take effect only after the right treatment has been recommended. This period is important because it is the main determinant to ones acceptance of a claim. Any exclusion period imposed should not last longer than one year. During this period, the claimant is credited for the previous coverage.
During instances where a member wishes to move from one company to another, the person in charge of the other cover is allowed to inquire details of the previous plans. This is important because it helps plan for the new entitlement for exclusion. This is also necessary just in case that there is a benefit that is included or not included in the new plan. The good thing is that notice is given for any pre-existing medical condition, which is written.
Most public and private institutions that offer coverage are usually categorized as creditable. This coverage includes Medicare, foreign coverage, student coverage, personal or individual coverage, military coverage and much more.
Group health insurance benefits and exclusions usually differ. Exclusion periods also vary from one company to another. This means that exclusion periods imposed on pre-existing medical conditions may not be covered in some plans. This means that it is generally advisable for one to look around and to shop for the most suitable cover in order to ensure that they get the best deal.
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