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How do pre-existing conditions affect ERISA claims in Texas?  

On Behalf of | Jan 16, 2025 | ERISA Claims | 0 comments

When you switch jobs in Texas, your health issues can affect your new benefits plan. This matters most to workers in Austin’s growing job market, where changing employers happens often. Here’s how pre-existing conditions affect your ERISA claims. 

What counts as a pre-existing condition?  

A pre-existing condition is any health problem before your new insurance starts. While regular health insurance must cover these conditions thanks to the ACA, disability and life insurance plans under ERISA work differently. Here’s what to expect:  

  • Insurance companies can check your medical history from the past 6 months 
  • You might wait longer for coverage of existing health issues 
  • Your plan may limit benefits for ongoing health problems 
  • Prior medical care affects what your new plan will cover 

Always read your policy papers to know exactly what your plan covers.  

Your rights in Texas  

ERISA gives you specific rights when it comes to pre-existing conditions. Texas law backs these protections to help you get fair treatment:  

  • Your plan must tell you about any limits on pre-existing conditions 
  • Time with your old insurance counts toward waiting periods 
  • Plans can’t count your genes as pre-existing conditions 
  • Pregnancy is never a pre-existing condition

Keep all your medical records and doctor’s notes in one place. Talk to your insurer about your health issues right away. If your insurer denies your claim, you have the right to appeal.   

Remember, the more proof you have about your health history, the better your chances of getting the benefits you need. If you run into problems, Texas law gives you the right to fight back through ERISA’s appeals process. Consider seeking legal help to improve your chances of getting approved. 

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