You can either have a discretionary grant or not, but you can’t make it discretionary for them — at least not until you’ve done your job for them.
What are pre-existing condition requirements?
You must pay a pre-existing condition or medical loss fee before coverage can kick in unless you meet these requirements:
You’ve been diagnosed with, or have had in the past six months a major medical condition (i.e. cancer) that affects your capacity or willingness to work
You’ve been living as a conditionally insured person under either a contract or a managed care plan with your employer (or the plan has your name as the beneficiary) and you have no other medical coverage
You haven’t applied for or been approved for health care coverage
You’re receiving full-time education because of your work experience
You can’t have pre-existing condition coverage unless you apply within 60 days of having the medical condition.
You can’t use a contract or managed care plan to purchase the pre-existing condition coverage until a plan form is approved. That means you can’t buy coverage through a group plan or a health insurance exchange. You can only pay for the coverage through the new Marketplace or a job you want to do, such as in a nursing home or VA facility.
To do this, you need to request coverage through the Marketplace or through a job, such as in a nursing home or VA facility. You may be asked questions about this form once your job is on the site.
There are some exceptions to the pre-existing condition requirements, including people with pre-existing conditions and those who have a mental illness or epilepsy. Also, a mental illness or epilepsy can be determined more easily during the Marketplace application process, but not during the physical exam.
You can’t use a pre-existing condition or medical loss fee on health savings accounts, prescription drugs, or for anything else, and you must take the fee every year in order to keep your coverage or your coverage can end if you don’t keep up with it.
So how do you calculate the pre-existing condition?
It’s usually based on the length of time a person has been insured, but it’s also based on what’s known as the “coverage gap.” The coverage gap is the difference between the cost of your current health coverage for the time you have it and the cost of covering the cost of an item you had when you stopped.
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