Saturday, May 15, 2010

Pre-existing condition / Diabetes for Group Health/Dental Insurance?

The last time I saw my doctor for my Type 2 diabetes in the U.S. was in August, 2003. I went overseas soon after that and didn’t come back until recently (I didn’t have coverage during this whole time). I just got a job which offers group health insurance, does my diabetes counts as pre-existing condition. (I’m choosing a BCBS PPO plan), and can they impose exclusion period?





I live in Pennsylvania, and according to my research, Group health plans in PA can count as pre-existing conditions only those for which you


actually received (or were recommended to receive) a diagnosis, treatment or medical advice within the 6 months immediately before you joined that plan. So it appears to be that I should have no problem if I go to see my doctor for my diabetes right after my policy become effective on Jan. 1st, 2008, right? I want to make sure.





Similarly, I had dental surgery for gum problems in 2002, will my group dental plan look back 6 month only?





Thanks for your answer

Pre-existing condition / Diabetes for Group Health/Dental Insurance?
If you have diabetes you've had "treatment" for the past 6 months, even if it was just diet to control your blood sugar. So yes, the insurance company will consider that a pre-existing condition. Also, if you have any type of health condition, even if you haven't had any treatment, it is still considered a pre-existing condition.





However, it also depends upon the BCBS group plan. Group plans can be tailored in any way (unless it's contrary to state law) so the only way to know is to contact the insurance company or your company HR department.


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