Sun Devil 92
Diamond Member
- Apr 2, 2015
- 32,078
- 11,094
- 1,410
- Banned
- #61
A preexisting condition did not apply unless the insurance company can prove that the insured knew the condition existed.
Pre-existing conditions limitations were defined as condition occurring for 12 months before coverage became effective, and applied for 24 months if claims were incurred in the first 12 months, or a total of 12 months if no claims for the condition were incurred during the 12 months. Credit toward the PEL applied to the extent that the individual was continuously covered without interruption by the prior carrier, if the group policy replaced a prior policy.
All coverage for the individual could be denied based on unacceptable evidence of insurability. Evidence of insurability was required if the employee failed to apply for coverage of an eligible depended within 31 days of becoming eligible. EOI was required of any employees who failed to apply during the 31 days following the date the employee became a full time employee, usually defined as an employee regularly scheduled and working for at least 30 hours per week. Later, HMO's were required to have a 30 day "open enrollment" every year in which no EOI was required for late enrollees.
If, after insuring an otherwise eligible employee or dependent, if the insurance company determined that the applicant's EOI misrepresented the health status of an employee or dependent during the first 12 months of coverage, coverage could be rescinded and premiums returned. I did this often.
All of the above has been wiped out, and is illegal under ACA.
If that is what is so great about the ACA, you've got pretty low standards.