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  • Group Health Insurance Restrictions


    Most insurance companies have a maximum pay limit for their hospitalization insurance for services such as room and board, surgery expenses, drugs, nursing care and time spent in hospital. Hospitalization health insurance can sometimes have separate limits for each type of coverage and, consequently, separate deductibles for the patient. Furthermore, even when hospitalization insurance is part of existing health insurance coverage, it is not always guaranteed.Learn more about hospitalization insurance.

    Pre-existing Conditions

    It is easier to qualify for health insurance with a pre-existing condition with a group health plan offered by an employer than with an individual health insurance plan.2

    However, under no circumstance can you be turned down, charged more or face a pre-existing exclusion period because of your genetic information. Genetic information includes the results of a genetic test and your family history of health conditions.3

    There are also certain protections allotted to those with pre-existing medical conditions. Under the Health Insurance Portability and Accountability Act (HIPAA), individuals are entitled to have pre-existing medical condition treatments paid for by the new insurance company. Under this act, those who have previously been insured under a group health insurance plan and are obtaining a new type of health insurance may be able to have their pre-existing conditions covered as long as they meet certain criteria.

    It is important to note that HIPAA relates to individuals who have been previously insured under a group health plan and not an individual health insurance policy. With that said, should you fall into this category, take advantage of HIPAA when switching from one group policy to another group policy. This will prevent you from having to pay for costly insurance due to a pre-existing condition or having a hard time obtaining health insurance altogether.4

    1U.S. Insurance Online,“Hospitalization Insurance” 2Health Insurance Resource Center, “Individual Health Insurance – Coverage For Those Without an Employer-based Plan” 3Georgetown University Health Policy Institute, “CT Consumer Guide to Getting and Keeping Health Insurance: Individual Health Insurance Sold by Private Insurers” 4MedHealth Insurance, “Pre-existing Conditions and Health Insurance”