A Answers (3)
Michael Roizen, MD, Internal Medicine, answeredIf you have diabetes and join a group health insurance plan through your employer, you will be covered for treatment, although there may be a waiting period. If you are buying the insurance for yourself, in some states you can be denied insurance or may have to pay a high premium until 2014. At that point, the Affordable Care Act of 2010 (the recent healthcare reform act termed “Obamacare”) will prohibit health insurers from being able to deny coverage or charge a higher premium for a pre-existing condition such as diabetes.
Honor Society of Nursing (STTI) answered
Health insurance coverage varies from state to state and plan to plan, but there are some general laws regulating insurance coverage. A large group plan sponsored by your employer is not allowed to deny coverage based on your health status. Individual, independent insurance plans are not regulated in the same way. Some individual plans offer insurance coverage for people with diabetes, and other chronic illnesses, but at a higher rate because of the high-risk status. In 46 of the 50 United States, you cannot be denied coverage for basic equipment and supplies but levels of coverage still vary from plan to plan.
American Diabetes Association answeredEmployer sponsored group health insurance plans are not allowed to turn you down based on your health status. Some employers require newly hired employees to take and pass a physical exam (or to fill out a health questionnaire) before enrolling in health coverage.
Individual health insurance policies, however, are not subject to the same consumer protections. The individual health insurance market in most states is characterized by "medical underwriting." That is, insurers in this market decide whether to sell coverage (and if so, what benefits to offer and what premium to charge) based on the health status, prior medical history, age, gender, and other characteristics of applicants. Diabetes is a condition for which most medical underwriters will automatically deny coverage. However, this is not true in all states.
For example, in a few states, medical underwriting is illegal. In others, only certain residents must be sold individual health insurance policies. Still other states designate one or more insurance companies (usually Blue Cross Blue Shield) as "insurers of last resort" who cannot turn individuals down for coverage based on their health status. For more information on individual policies in your state, please visit the Georgetown University Health Policy Institute's Web site for a health insurance consumer guide for your state.
In most states, all private insurers in the individual market can medically underwrite coverage at least some of the time. Many (though not all) of these states establish high-risk pools that offer coverage to certain "uninsurable" individuals whom private insurers turn down.
Additionally, a federal law, called Health Insurance Portability and Accountability Act (HIPAA), requires private insurers to guarantee coverage to qualified individuals (known as "federally eligible individuals") who are leaving group health plan coverage and meet certain requirements. For more information about your rights, please refer to your state consumer guide.