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marc2oni asked in Politics & GovernmentPolitics · 1 decade ago

Healthcare, adults with pre-existing conditions?

healthcare reforms getting passed. im reading and children with preexisting conditions (PEC'S) can not be denied coverage immediately. when will that kick in for adults? when it does take affect, whenever that is, and adults with PECs can not be denied, will they be forced to pay more for their coverage?

*please no personal opinions on the reform bill. just looking for answers to my questions. thx.

Update:

ron r. your answer doesnt make sense. but thx for trying though.

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anyone know the answer to my question? its appreciated.

2 Answers

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  • 1 decade ago
    Favorite Answer

    Ignore the previous post, your condition WILL be covered (in fact, they are covered today, usually after 12 month waiting periods). The waiting periods will be banned except in special consumer (individuals not affiliated with group plans) cases, and the law says the waiting period can only be 3 months (See section 167 of the House bill).

    Since banning pre-existing conditions clauses was supported by both Republicans and Democrats early on, the new reconciled bill didn't need to readdress it.

    From the House Bill:

    SEC. 111. PROHIBITING PRE-EXISTING CONDITION EXCLUSIONS.

    A qualified health benefits plan may not impose any pre-existing condition exclusion (as defined in section 2701(b)(1)(A) of the Public Health Service Act) or otherwise impose any limit or condition on the coverage under the plan with respect to an individual or dependent based on any health status-related factors (as defined in section 2791(d)(9) of the Public Health Service Act) in relation to the individual or dependent.

    {EFFECTIVE DATE-

    (A) IN GENERAL- Except as provided in subparagraph (B), the amendments made by this subsection shall apply with respect to group health plans for plan years beginning after the end of the 6th calendar month following the date of the enactment of this Act.}

    The concept behind a pre-existing condition clause is directly related to the U.S. not having universal health insurance. Systems that have universal insurance (every other industrialized nation on Earth) don't have pre-ex issues because people pay into the health insurance system whenever they start working.

    A pre-existing condition clause is only needed in a broken system like ours whereby coverage is not mandated. People avoid getting policies and don't pay a dime into the health insurance system, but then show up on the doorstep of an insurer asking for coverage. The insurer doesn't want to pay for an expensive, non-acute condition for a subscriber who has not contributed financially to the risk pool.

    With mandated coverage, pre-existing condition clauses will disappear. Everyone will be fully insured (depending on their coverage; elective and cosmetic procedures, for example, might not be covered).

  • Ron R
    Lv 6
    1 decade ago

    to answer your questions.....you can not be denied because of a pre existing condition...however that condition is not covered by the insurance......clear enough...besides the government already has a pre existing condition for being denied medicaid....it is called ..."income".....if you have any you do not qualify for the coverage but you do qualify for the payment so others can be covered.....lol....wake up

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