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November 2, 2003


Question from California, USA:

Is is legal for an insurance company to deny benefits to a child with diabetes citing “pre-existing condition”? If law is different in other states, please give names of states in which law is not practiced. What should I do to insure my child when our health plan runs out?


From: DTeam Staff

Whether or not an insurer can impose a preexisting exclusion clause on a new member coming into their plan depends on a number of factors. Some of them are: Is the coverage from an insurer or an HMO? Is the coverage being offered through an employer’s self-funded or self-insured group benefit program? If not, is the new coverage group coverage (like signing up for the plan offered at your job) or is it individual coverage you have purchased from an insurer or HMO? Has the person had at least 18 months of prior health insurance coverage without more than a 62 day break in coverage during that period?

I urge you to learn more about your health insurance options at healthinsuranceinfo.net which is a non-profit, consumer website produced by the Georgetown University School of Health Policy. I am certain that you will be able to find some answers to your questions there.