When can an insurance company deny coverage based on a pre-existing condition?

An insurance company can deny coverage based on a pre-existing condition under the conditions specified in the Affordable Care Act (ACA). The ACA prohibits insurance companies from denying coverage or charging higher premiums based on pre-existing conditions. However, it does allow for certain exceptions, particularly during a limited enrollment period or for plans that are considered "grandfathered" and have not been altered significantly since the ACA was enacted.

This means that during open enrollment periods or for qualifying events, insurers cannot take pre-existing conditions into account when determining coverage options. Outside of these specified conditions, the regulations protect individuals from discrimination based on health status. Thus, understanding the circumstances under which coverage can be denied is crucial for both insurers and consumers in navigating health insurance options.