Pre-Existing Conditions and Kaiser Permanente

With the exception of children younger than 19 and adults who are seeking group health coverage, people with pre-existing health conditions can still be denied for private medical insurance. The eligibility criteria varies according to each insurance company, but basically, underwriters are looking for health issues that are recurring, chronic, or severe.

High risk medical conditions commonly result in ineligibility for private health care. Other issues that could potentially result in non-approval would be behavioral disabilities, a worker’s comp injury where the claim is still open, and being an expectant mother or father. Other situations where a person could be denied would be silicone breast implants, being at an unhealthy weight for your height, heavy or frequent alcohol or tobacco use, taking illegal drugs, or having a prescribed medical procedure or treatment that has not been taken care of. Sometimes, a denial could be due to a combination of minor issues, which together, create a medical concern for underwriting. Being a chain smoker, in itself, might not be grounds for an automatic non-approval, but being an overweight chain smoker who is on high blood pressure medication could potentially lead to non-approval. The above are possible reasons for a denial and are not intended to suggest that you will automatically be denied. To find out for certain, submit an application so that the underwriter can make a determination.

There is some good news. In year 2014, no one can be denied health insurance due to pre-existing medical reasons. Between now and then, there are a few medical insurance options for people with pre-existing health conditions. One of the best alternatives is group health insurance. If you are a business owner with at least two people working for the company, or you are employed at a company with a minimum of two workers, consider a group medical plan. The price for the group health insurance may be a little cost-prohibitive, but if you can manage it until 2014, that could be a very wise way to manage your health care in the meantime.

Kaiser Permanente small group health insurance plans offer extensive benefits that work well for people with ongoing treatments or medications. For example, the non-HSA deductible plans in California cover mental health therapy visits at a discounted flat fee. Although these standard deductible plans include a deductible, the deductible would not apply to the mental health visits. This means you would pay a low fee for the service, as well as have an affordable premium for the plan itself.

As a Kaiser Permanente member, you would also have an opportunity to participate in classes that could help create a healthier you. There are classes that cover depression management, eating disorders, and living well with diabetes. Additionally, there are support groups for people dealing with cancer and other life issues. There is something for everyone. To view a list of available classes and locations, visit the Kaiser Permanente website by clicking here.

If a group insurance plan is not an option, another alternative is the Pre-Existing Condition Insurance Plan (PCIP). This is a new program that is federally-funded; not all states have adopted it. In CA, it is operated by the Managed Risk Medical Insurance Board (“MRMIB”). To qualify, you will need to be an American citizen, uninsured for at least 6 months, and have previously been denied health insurance. For more information about the PCIP option, click here.


Comment from Donald Eric Christian
Time: March 25, 2011, 9:35 am

I was diagnosed with Hepatitis C in 2010. I know that I can’t be covered for that but would still like to purchase some type of health care plan.

Comment from Raymond Martel
Time: March 28, 2011, 2:53 am

I was a member with kaiser since 1979. But I was refused continued coverage because I had to complete two applications. The second one was not inside the time limit. I’m angry. But so what, right?

Comment from Esmeralda
Time: March 30, 2011, 12:31 am

If you applied for a private plan and were denied because:
– The application was incomplete, I would invite you to apply again.
– For medical reasons, you might be able to apply again. If the medical condition has improved, you can reapply providing there has been at least 6 months since the application was declined.

By any chance, are you a business owner? If yes and you have a second person working for the company, you could be eligible for group insurance, which is not subject to medical underwriting.

Following are some options you might consider:

1. If you (or your spouse) are a businessowner, and have a second person working for the company, you might qualify for group insurance. Please visit for rates and plans.

2. You might qualify for “MRMIP”, which is a state-regulated health plan for people who’ve been denied insurance before. For more information, call 1-800-289-6574.

3. Medi-Cal? More information is available by calling 1-888-747-1222.

4. Also, you can visit “” and “” to see what’s available in your state.

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