Insurance Change and Pre-Existing Conditions

Last Modified: November 1, 2001

Dear OncoLink "Ask the Experts,"
I am considering changing from my current health insurance coverage (BC/BS of the National Capital Area) to my husband's insurance (BC/BS government employee) coverage during open enrollment. Since I was diagnosed with localized malignant melanoma 6 months ago, I was concerned that changing health insurance may create problems for us with respect to coverage of a "preexisting condition" if I am later seen by a doctor for a related health problem. I called my husband's health insurance customer service line and was assured that a preexisting condition would not affect my coverage. Can I believe this? Should I contact anyone else before we make the change?

Since the open enrollment period ends December 10, I'd appreciate a prompt reply. I only discovered your service today; otherwise I would have written earlier.  

Employers are typically offered the option of including or excluding a pre-existing condition clause. Inclusion will mean an added expense to the employer, translating into a higher premium for employees. Pre-existing condition clauses are typically customized for the employer, and may have different requirements for employees versus their dependents. For instance, the employee may be covered from day one for a pre-existing condition but the spouse (or other dependent) may not be covered for a period of six months. In other words, not all pre-existing condition clauses are alike, and we strongly urge you to obtain written confirmation that you will be covered. Contact your husband's health insurance customer service line and request a copy of the pre-existing condition clause, and/or a letter specifying the terms of the conditions. We do not recommend that you change your coverage until this information is received, reviewed and deemed acceptable.

From the National Cancer Institute