Subscribers and dependents must satisfy a 12-month waiting period for pre-existing conditions under this health benefit plan. Any waiting period for pre-existing conditions begins on the effective date of this health benefit plan. During a waiting period for pre-existing conditions, neither you nor your dependents will receive benefits for conditions for which medical advice, diagnosis, care or treatment was recommended or received within the 12 months immediately preceding the effective date of this health benefit plan. However, provided there was no significant break in coverage, a waiting period for pre-existing conditions will not apply to any condition first identified, treated and covered under prior creditable coverage. Medical records may be ordered to make this determination. Genetic information [variable] is never treated as a pre-existing condition.

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WHEN WILL THESE NEW REFORMS BECOME EFFECTIVE:

Beginning in July 2010 – Consumers with health problems who have been uninsured for 6 months may be eligible to obtain coverage through a new high risk pool program. And a temporary reinsurance program will help employers who provide coverage to their retirees in maintaining this coverage. 

Beginning in plan years on or after September 23, 2010 – Pre-existing condition exclusions are prohibited for children under 19, dependents up to age 26 will be able to obtain coverage through parents’ health plans, routine preventive care will be covered without cost-sharing, limits on lifetime coverage will be eliminated along with other changes. 

In 2014 – Individuals and small businesses will be able to purchase coverage through state-based exchanges. Consumers will be able to purchase health insurance regardless of health status and premiums cannot vary because of health status. Individuals will be required to purchase health insurance or pay a penalty. Subsidies will be available on a sliding scale to help individuals or families with incomes up to 400 percent of the federal poverty level to purchase insurance through new state-based exchanges.

The above information is from a post by BCBSNC in 2010. 

 For more information on health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our qualified agents. Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC). You may qualify for a 15% healthy lifestyle discount if you are in excellent health. Call us for details.

Pre-Existing Conditions

A pre-existing condition is a medical condition diagnosed or treated before joining a new plan. In the past, health care given for a pre-existing condition often has not been covered for someone who joins a new plan until after a waiting period.

Under the law, most of which goes into effect on July 1, 1997, a pre-existing condition will be covered without a waiting period when you join a new group plan if you have been insured the previous 12 months. This means that if you remain insured for 12 months or more, you will be able to go from one job to another, and your pre-existing condition will be covered. without additional waiting periods. even if you have a chronic illness.If you have a pre-existing condition and have not been insured the previous 12 months before joining a new plan, the longest you will have to wait before you are covered for that condition is 12 months.

To find out how this new law affects you, check with either your employer benefits office or your health plan.

For more information on health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our qualified agents.  Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC).  You may qualify for a 15% healthy lifestyle discount if you are in excellent health.  Call us for details.