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A pre-existing condition is a medical condition diagnosed or treated before joining a new plan. In the past, health care given for a pre-existing condition often has not been covered for someone who joins a new plan until after a waiting period. However, a new law—called the Health Insurance Portability and Accountability Act—changes the rules.
Under the law, most of which goes into effect on July 1,
1997, a pre-existing condition will be covered without a waiting period when you
join a new group plan if you have been insured the previous 12 months. This
means that if you remain insured for 12 months or more, you will be able to go
from one job to another, and your pre-existing condition will be covered—without
additional waiting periods—even if you have a chronic illness.
If you have a pre-existing condition and have not been insured the previous 12
months before joining a new plan, the longest you will have to wait before you
are covered for that condition is 12 months.
To find out how this new law affects you, check with either your employer
benefits office or your health plan.
What Plan Benefits Are Offered?
Most plans provide basic medical coverage, but the details
are what counts. The best plan for someone else may not be the best plan for
you. For each plan you are considering, find out how it handles:
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Physical exams and health screenings.
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Care by specialists.
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Hospitalization and emergency care.
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Prescription drugs.
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Vision care.
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Dental services.
Also ask about:
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Care and counseling for mental health.
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Services for drug and alcohol abuse.
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Obstetrical-gynecological care and family planning
services.
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Ongoing care for chronic (long-term) diseases, conditions,
or disabilities.
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Physical therapy and other rehabilitative care.
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Home health, nursing home, and hospice care.
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Chiropractic or alternative health care, such as
acupuncture.
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Experimental treatments.
Some plans offer members health education and preventive
care, but services differ.
Ask questions such as:
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What preventive care is offered, such as shots for
children?
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What health screenings are given, such as breast exams and
Pap smears for women?
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Does the plan help people who want to quit smoking?
» Continue to - What Is Most Important to Me in a Plan?
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