What is a Health Plan Rider?

Every health plan comes with limitations on the coverage it offers. But if you have a pre-existing health condition, your plan may include additional limitations on coverage. These extra limitations will be outlined in a document attached to your plan, called a rider.


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How Do Riders Work?

When you apply for health insurance, you’ll answer a long series of questions about your medical history. If you have a current medical condition, your plan will include a rider that limits your coverage for care related to that condition. Usually, that limitation will be in effect for a year.

Here’s an example: let’s say you have a back injury when you apply for coverage. The insurance company will likely accept your application — but they also might include a rider on your plan that limits your coverage for treatment related to your back injury. This limitation, or exclusion period, will probably be in effect for a year. After the exclusion period, any medical services related to your back injury will be covered normally under the terms of the plan.

Why Do Health Plans Include Riders?

All kinds of insurance have one thing in common: they’re designed to protect you against risk. Insurance plans do that by spreading the risk around. In health insurance, this is done by having plenty of healthy people paying their premiums. These premiums offset the cost of the medical bills incurred by a plan member who gets sick or injured.

One of the misconceptions of health insurance is that you only need it after you get sick. But if people only paid for insurance when they needed it, no one would be able to afford it.

That doesn’t mean you’ll necessarily be denied health insurance if you have a pre-existing condition. But your health plan will likely include a rider, and you may have to wait up to a year before care related to that condition will be covered.

If you have a pre-existing condition, it’s a good idea to work with a professional agent. Many agents work with several different insurance companies, and they’ll be able to point you toward the plan most likely to accept your application and attach the fewest limitations on your coverage. You can connect with several agents using our free service. It’s no-risk, and you have no obligation to buy.

You can also compare plans online. Just fill out a simple form to get view quotes in minutes.