Part of the Affordable Care Act (ACA) mandates that health insurers cannot discriminate against individuals who have Pre-existing Medical Conditions.
It is against the law for the insurer to:
- Reject your application
- Charge you a higher premium
- Refuse to pay for treatment of any condition that existed before your health insurance coverage began
- Deny coverage once you have the policy
- Raise rates based on your health or claims history
Additionally, Medicaid and CHIP (Children's Health Insurance Program) cannot refuse coverage or charge more because of a Pre-existing Condition.
The ACA requires health insurance to cover pregnancy from the day your policy starts.
If you were pregnant when you applied, the insurer cannot reject you or charge you more due to pregnancy.
The policy covers pregnancy and childbirth services from the first day of coverage. Also, childbirth or adoption triggers a special enrollment period, allowing you to enroll or change plans. You have a 60-day window to enroll from the date of birth or adoption.
Older, grandfathered plans are not required to cover Pre-existing Conditions or preventative care.
If you currently have a grandfathered plan, you have two options if you want Pre-existing Condition coverage:
- Switch during open enrollment to an ACA-compliant plan
- Qualify for a special enrollment period if your grandfathered plan ends outside of open enrollment
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