Can Health Insurance Be Backdated?

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by Tiffany M.
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As is most cases, this depends on your insurance carrier and their rules. However, in a majority of cases, health insurance cannot be backdated. Rest assured, all the information you will need regarding backdating your insurance will be discussed in this article to help you through the process – if your insurance accepts backdating, that is.

What is Backdating in Insurance?

In terms of health insurance, backdating refers to your insurance carrier pushing back the effective date of your plan. For example, if you are accepted into your insurance plan on January 1st, but you paid your first premium a week later, backdating would allow you to file claims on medical expenses that date back as far as January 1st rather than your day of payment. This can be beneficial to obtain cheaper costs or better policies that may vary by age or enrollment date.

Benefits of Backdating

The most common benefit that comes from backdating is avoiding any late fees or policy fees that are associated with age. Here is an example of a common situation:

You obtain a quote for a health insurance plan at the age of 40. You get accepted for your insurance plan at the age of 40 as well but you are not able to pay the first premium for two weeks. It was your birthday within those two weeks and you are now 41 years old. Since you paid your first installment when you were 41 years old, your new effective date begins at 41 years. Since you are now older, your insurance carrier has a different policy in place for your new age group. This can result in different coverage or different prices. 

With backdating, your insurance carrier will move your effective date back to when you were first accepted into the plan rather than when your first premium was paid. Therefore, you will gain the advantages of your original quote. 

Backdating in The Health Insurance World

Although backdating may be beneficial to your circumstance, the unfortunate truth is that many health insurance companies do not allow for backdating. You can usually find their policies regarding backdating in your plan agreement. However, if they do not mention backdating or their effective date policy, make sure to contact a representative of your health insurance carrier to ask them about backdating directly. 

What Are The Policies That Prevent Backdating?

There are several policies and reasons that health insurance companies prevent backdating. There are some exceptions to get around these policies but many healthcare insurance companies stand firm on their backdating policies. Below are a few of the main policies that insurers use to prevent backdating.

Effective Date

The effective date of your insurance is the day your insurance policy officially becomes active. Many times people mistake their effective date for their acceptance date. It is important to take note that these dates are not the same and any health expenses prior to your effective date will not be covered by your insurance company. Effective dates vary from one insurance company to the next, so it is important to discuss this policy with your insurance representative. Effective dates may prevent backdating since they clearly state when the effective date starts (depending on your carrier) and backdating would change the signed agreement of your effective date.

When Do Effective Dates Start?

Typically, effective dates start the day your first monthly premium payment was processed. In some cases, your insurance carrier may determine that your effective date is the same as your acceptance date. It is important to determine what your effective date policy is with your insurance carrier to avoid any confusion, miscommunication, or payment complications.

Waiting Periods

Waiting periods are set time periods that are set in place by health insurance companies to ensure their consumers are not solely purchasing an insurance plan right before a costly surgery or treatment plan. This keeps general costs low for everyone and avoids sudden health treatment costs for new patients for the insurance company. These periods vary on the insurance company but all maintain the same concept. There are several waiting period lengths for different circumstances such as accident coverage, existing condition coverage, and hospital coverage (to name a few). During these waiting periods, coverage is not provided under your new policy. This protects health insurance companies from backdating since coverage will not be provided until after the waiting period, regardless of your need. 

Discussing Backdating and Your Effective Date With Your Insurer

When determining the benefits and coverage for your healthcare plan, it is important to discuss your effective date and backdating with your insurer. If your insurance company does not endorse backdating, it is important to try to negotiate backdating your plan if necessary. Negotiating is always an option with your insurer, contrary to popular belief. Although it might not always work out, it is always worth a try. When negotiating, it is important to note the difference in time between your effective date and acceptance date, as well as any planned medical treatments.

What Are Some Exceptions For Backdating?

Although backdating your healthcare plan may be difficult, it is not impossible. There are a few exceptions to backdating that may be beneficial for you if you are negotiating your effective date with your insurance company. Below are two exceptions that you may qualify for. 

Adding Child As Dependent

If you are adding a child to your healthcare plan as a dependent, whether the child is a newborn or a dependent through adoption, fostering, or a joint-marriage, your healthcare plan will be backdated. Any waiting periods will also be waived for the new child added. However, you must add your new dependent to your plan within a certain time frame – usually between two to three months after the addition to your family – to avoid these waiting periods and be able to backdate your plan.

Health Insurance Provider Switch

Another exception to backdating your plan is switching your health insurance provider. If you switch providers, any time spent in a waiting period with your previous provider will transfer, but you must make sure you don’t end up with a gap in coverage between the end of your previous insurance policy and the beginning of your new one. If your initial waiting period has already passed, you will not have to repeat a second waiting period. Avoiding the waiting period will allow the possibility of backdating your plan.


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