Insurer cannot cancel plan for pre-existing conditions

Can the insurer cancel my plan if I don’t tell them all of my pre-existing conditions?  I’m going to be applying for my own coverage soon: because of my health, I can only work part-time and part-timers don’t get the plan at work.  I want to tell the insurer only what they need to know and I’d rather not have my health history out there for the world to see.

On Edge In Maryland

Dear On Edge In Maryland,

The insurer could cancel your policy only you committed fraud on the application. This was part of the health reform law of 2010, limiting the insurer’s ability to end a person’s coverage. So, for example, if you lied about being married to someone on your application for family coverage, they could cancel your policy.

In Maryland, insurers are allowed to charge people more or turn you away based upon their health.  This is true until 2014, when this practice is prohibited.  If you cannot find a willing insurer, you can apply to Maryland Health Insurance Plan (MHIP); this is specifically for people who can’t get insurance because of their health.

Once you have a new plan, you should be all set for having your pre-existing condition covered – as long as you do not have a gap in your health coverage of 63 days or more.  You will probably have to show the new plan that you had uninterrupted coverage, as soon as you get a service for your pre-existing condition.  When the insurer gets a claim for an ongoing (chronic) illness like diabetes or depression for a new member, they will ask you to send them proof of “creditable coverage.” This is a form that you would request from your previous insurer.  Once they have that form, they will be able to pay the claim (assuming you had no gap).

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Linda Riddell

About Linda Riddell

A published author and health policy analyst with 25 years’ experience, Linda Riddell's goal is to alleviate the widespread ailment of not knowing what your health plan can do for you.