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preexisting condition


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Posted by Insurance Guru on March 08, 2001 at 07:39:54:

Curious about pre-ex when switching plans from an HMO
to another plan type, i.e.traditional/indemnity coverage.
Is this example correct?
Therefore suppose Patient A is currently enrolled in an
HMO group health plan and wants to see a specialist
recommended to her who is not in the HMO network.
If patient does so, he/she will bear the full cost of
the visit. However, if patient has the option to
switch to another health plan offered by his/her
employer where the specialist is a participating
physician, patient's new health plan cannot deny
coverage for eligible benefits (i.e. physician visits)
simply because the patient was recently diagnosed with
cancer. This is contingent on the federal
(Kennedy-Kassembaum) and state laws that protect
consumers with creditable coverage of continuous
enrollment for the 18 months prior to a health plan
switch.

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