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From Arlington, Texas, USA:

My husband lost his job and I have recently taken out an insurance policy through my employer. We had been struggling with money and his insurance lapsed before I could take out a policy. The policy that I have taken out has a pre-existing condition clause. I was told by daughter's nurse that in the state of Texas they could not have a pre-existing condition clause for life threatening illness. Is this true? If so, what can I do?


If I understand your question, you want to know under what circumstances your family has to go through a pre-exisitng waiting period, even though you moved from one group health insurance policy to another, but with a break in between the coverages. Generally, federal law requires that when you change from one group health plan to another you receive credit for prior coverage towards satisfying a pre-exisitng exclusion clause. However, if you have a break in coverage of 63 days or more, you may have to satisfy a new pre-existing condition exclusion period when you join a new group health plan. Even if your coverage is continuous, there may be a pre-existing condition exclusion period for some benefits if you join a group health plan that covers benefits your old group plan did not. For example, say you move from a group plan that does not cover prescription drugs to one that does. You may have to wait up to one year before your new health plan will pay for drugs prescribed to treat a pre-existing condition. However, your question did not provide enough detail for me to hone in on your specific concern. I would encourage you to review A Consumer's Guide to Getting and Keeping Health Insurance in Texas, published by the Georgetown University Health Policy Institute, particularly the chapter discussing your protections in group health plans.


Original posting 24 Jun 2007
Posted to Insurance/Costs


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Last Updated: Tuesday April 06, 2010 15:10:12
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