Do birth defects in children count as pre-existing conditions?
My family is shopping for new insurance at the moment. We reside in the United States, Georgia specifically. We have had insurance continuously since she was born. My daughter, born in 2011, was born with hip dysplasia and a cleft lip and palate, both considered birth defects. She has had several surgeries, but has no operations scheduled. At the moment we are shopping for individual coverage (I'm self employed) not the exchange.
My question: should one of her doctors decides she needs a procedure or operation of some kind, would that be considered a pre-existing condition, and hence not covered?
Update after talking with Insurance Broker - We are faced with (AFAICT)
If we go with an exchange plan - we lose most of our doctors, but the birth defects are not considered pre-existing in any way
If we go with a non-exchange plans we get to keep all of our doctors, but any actions related to the birth defects are in a gray area. She has nothing scheduled, pending, or needed at the moment. The only real question is what if a doctor decides that something needs to be done about something related to the birth defect. The broker did not know the answer to that.
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No. Since 2014, the concept of pre-existing conditions affecting coverage or rates no longer exists in the US:
Under current law, health insurance companies can’t refuse to cover you or charge you more just because you have a “pre-existing condition” — that is, a health problem you had before the date that new health coverage starts.
These rules went into effect for plan years beginning on or after January 1, 2014.
From Wikipedia:
In the context of healthcare in the United States, a pre-existing
condition is a medical condition that started before a person's health
benefits went into effect.
So in your case, no, this would not be considered a pre-existing condition since she has had coverage since birth. A condition that was diagnosed while you're covered by insurance does not become "pre-existing" if you switch insurance companies (there were grace periods for breaks in covereage before ACA and with proposed legislation).
Note that under current law, even if it was a "pre-existing condition", she could not be denied coverage.
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