The Affordable Care Act eliminated pre-existing conditions starting 2014. Insurance companies are no longer able to deny coverage, charge more, impose waiting periods, or deny treatment for anyone with pre-existing conditions. The only exceptions are procedures like cosmetic surgery that aren’t considered medically necessary.

The only medical question an insurance company asks that may affect your rates is your tobacco use. If you have used tobacco 4 or more days a week for the past 6 months, an insurance company is allowed to charge you 50% more than a non-tobacco user.

This page is included as a reference; pre-existing condition clauses still apply to grandfathered or group/company plans from before 2014; as well as short-term insurance plans.

Anthem Blue Cross and Blue Shield – Pre-Existing Conditions

Under the Anthem Indiana Health Insurance plans, Anthem will not cover any sickness or injury which is caused by, or results from, a pre-existing condition in the first 12 months of coverage under the health insurance policy. Anthem Indiana defines a pre-existing condition is defined as:

  1. A condition for which medical advice, diagnosis, care, or treatment was recommended or received during the twelve (12) months immediately preceding the member’s effective date under the policy, or
  2. A pregnancy existing on the member’s effective date under the policy, if maternity related benefits are provided under the policy.

Pre-Existing Condition Exception

Anthem has a very favorable pre-existing condition exception. Anthem will credit the time a member was covered by a prior qualifying health insurance plan against the 12-month pre-existing condition exclusion waiting period. For example, if I person was insured on an employer-sponsored plan for 6 months prior to obtaining an Anthem Blue Cross and Blue Shield health insurance policy, any pre-existing condition would be covered under their Anthem policy after 6 months instead of 12 months.

By providing this exception, Anthem follows the guidelines of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) even though HIPAA does not mandate health insurers to follow this procedure in administering individual policies, making this consumer-friendly extremely rare.

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