Some health insurance providers require a person to have an exam before they are eligible to purchase coverage. The reason for this is to see if the potential policyholder has any conditions that the insurance provider does not want to cover.
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Health insurance companies do not want to cover people with certain conditions or a history of certain conditions because they feel these people will cost them more money over time than those without these health issues. These types of exams are not limited to health insurance. People wanting to open a life insurance policy often have to undergo the same type of exam.
What is involved in a health insurance exam?
The things involved in a health insurance exam vary depending on the health insurance provider and the health care provider they use for the exam. The exam is usually the same type of exam someone would go through at a routine checkup.
The doctor will most likely listen to the person’s heart and lungs, weigh them, take their blood pressure, and inspect their ears, eyes, reflexes, throat, and just overall health. Some health insurance exams also require some type of blood work.
If blood work is required, the doctor will take a sample of the person’s blood and send it off to be analyzed. This type of analysis is checking for things like cholesterol levels and if there are any conditions, like STDs, the person is unaware that they have.
This type of exam might not be necessary at all when the person’s medical history is considered.
Pre-existing conditions will probably keep the person applying for coverage from reaching this step.
Some states do not require health insurance exams because they do not allow health insurance providers to exclude people based on their medical history. While this is an excellent policy to have because everyone deserves to be able to have access to affordable health care, insurance premiums tend to be much higher in these states because the insurance providers charge more. To learn more about the changes being made to these types of policies visit America’s Health Insurance Plans.
What are pre-existing conditions?
When someone first applies for a health insurance policy, they are typically asked about any conditions they have had in the past. If they have had certain conditions, they will most likely be denied coverage at that point and never be required to take the exam.
Someone being denied coverage because of a pre-existing condition mainly affects those that are trying to buy health insurance on their own. Health insurance coverage received through an employer does not usually have the same type of limitations because these programs have to be able to cover dozens or more people. While someone will probably not be denied coverage though their employer, based on their medical history, they might be required to pay more or to purchase supplemental insurance.
A pre-existing condition is any type of medical ailment a person has before the first day their insurance coverage is supposed to begin. While many people might think pre-existing condition exclusions only apply to those that have serious things in their medical histories like cancer or congenital heart defect, the truth is something as simple as a person’s weight or if they smoke can keep them from getting the health coverage they need.
What is HIPAA?
HIPAA stands for the Health Insurance Portability and Accountability Act that was passed into law in 1997. This law has an effect on many aspects of health insurance procedure including how insurance companies handle pre-existing conditions.
In a rare instance that someone is denied coverage in a group plan for a pre-existing condition, HIPAA ensures that this person will not be denied coverage forever. Because of HIPAA, there is something in the group insurance world known as an exclusion period.
This exclusion period places a limit on how long someone can be denied coverage because of a pre-existing condition. In most cases, this exclusion period can last no more than one year.
When it comes to individual health insurance plans HIPAA plays a smaller role, but can still be helpful. If under HIPAA someone is determined to be an eligible individual, they cannot be denied under plans for certain conditions. Each state has their own requirements, but people that are not able to get certain types of coverage such as Medicare or Medicaid might qualify as an eligible individual under HIPAA.
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