Exclusion Periods & Elimination Riders

About Exclusion Periods

Prior to health care reform, individuals with a pre-existing condition could be denied or charged more for health insurance. The Affordable Care Act is attempting to change this, so that the people who need coverage can receive it. Exclusion periods are frequently used by health insurance companies, to avoid responsibility to pay for treatment related to pre-existing conditions.

When an insurer establishes an exclusion period on a health plan, this makes the patient pay for all medical care related to that treatment out-of-pocket, until the exclusion period ends. Exclusion periods usually last from six months to two years, but in some states insurers are allowed to make them permanent. If the insurance company decides to make your exclusion period permanent, they will attach an elimination rider to the policy and never have to cover that type of care.

About Elimination Riders

Many health insurance companies are permitted by state law to give elimination riders to individuals with pre-existing conditions. An elimination rider is a document that permits all other approved medical services to be covered by insurance, with the exception of treatment for the pre-existing condition. Some insurance companies will deny you a health plan altogether if you have a pre-existing condition, so although you will pay for the treatment entirely out-of-pocket, at least you have other benefits.

Health care reform is attempting to put an end to discrimination against pre-existing conditions, so the people who need coverage can receive it for their chronic illnesses that should be treated. Some individuals may neglect to properly treat their condition if they are forced to pay for the medical expenses. The Affordable Care Act has already made is possible for children with pre-existing conditions to receive equal health insurance rights, and as of 2014, adults will have them as well.

According to the Nation Association of Health Underwriters, “under PPACA, as of March 23, 2010, health plans can no longer exclude, limit or deny coverage to a child under age 19 solely on the basis of a pre-existing condition. Beginning in 2014, insurers providing individual insurance will no longer be able to, in most cases, exclude, limit or deny coverage for any American solely on the basis of a pre-existing condition.”



1. National Association of Health Underwriters, “Consumer Guide to Individual Health Insurance”.