Uninsured and Planning to Enroll in an Employer-Sponsored Group Health Plan
I am uninsured and have been uninsured for at least 63 days (a significant gap in coverage):
Can a plan refuse to enroll me just because I am sick?
No. Employer-sponsored health plans may not refuse to enroll you just because you are sick. (There are exceptions to these protections for some church and state or local government plans.)
Can a plan charge me more based on my health?
No. Employer-sponsored health plans may not charge you or your family a higher premium than other employees who have a similar position in the company due to your health status.
Can a plan refuse to cover my illness for a period of time just because my illness was preexisting?
Yes. An employer-sponsored health plan may refuse to cover a preexisting illness for a period of up to 12 months. The length of time the plan may refuse to cover an illness for a new enrollee is sometimes reduced if that person has some creditable coverage, but you do not qualify for this reduction, since you were without health insurance for more than 63 days.
I am currently uninsured, but I had insurance until recently, and I have not had a gap lasting 63 days or more (a significant gap in coverage):
Can a plan refuse to enroll me just because I am sick?
No. Employer-sponsored health plans may not refuse to enroll you just because you are sick. (There are exceptions to these protections for some church and state or local government plans.)
Can a plan charge me more based on my health?
No. Employer-sponsored health plans may not charge you or your family a higher premium than other employees who have a similar position in the company due to your health status.
Can a plan refuse to cover my illness for a period of time just because my illness was preexisting?
Maybe. It depends on how long you previously had health insurance. Employer-sponsored health plans may refuse to cover a preexisting illness for up to 12 months. The length of time the plan may refuse to cover an illness is reduced based on how long you have had creditable coverage. If you previously had insurance for one year or more with no gap in coverage of 63 days or more, your illness cannot be excluded just because the illness was preexisting. However, your new insurance plan may not offer coverage for all of the same benefits covered by your former plan. Check your policy to see what benefits your plan will cover. If you previously had health insurance for less than one year, your illness can be excluded for some period of time.
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