Any health plan that is offered through employers and is under HIPPA (which is almost all employers) can have a maximum pre-existing condition exclusion period of 12 months (18 months if you don't enroll on the first opportunity but are a "late enrollee" instead). Pre-existing conditions are ONLY something that for which medical advice, diagnosis, care, or treatment was recommended or received during the 6 months prior to your enrollment date in a HIPPA plan. The example given on the Department of Labor HIPPA plan specifically mentions arthritis as an example:
"As an example, you may have had arthritis for many years before you came to your current job. If you did not have medical advice, diagnosis, care, or treatment - recommended or received - in the 6 months before you enrolled in the plan, then the prior condition cannot be subject to a preexisting condition exclusion. If you did receive medical advice, diagnosis, care, or treatment within the past 6 months, then the plan may impose a preexisting condition exclusion for that condition (arthritis)."
So even though you have BPI or some other long-term condition, if you have not sought or received treatment in the 6 months prior to enrolling on an employer-provided HIPPA plan, it still doesn't count as a pre-existing condition. My husband's shattered leg (and eventual need for a knee replacement) from our car accident in 2005 is not a pre-existing condition as he has not seen any doctor for it in over a year.
As for companies making up rules... expect it. It happens ALL THE TIME. People in the benefits office are NOT rewarded if they tell you the truth of what the plan covers. Expect it... but don't let them get away with it!!
When you get an insurance plan, request a copy of the Evidence of Coverage - EOC (they are required to give it to you). You can even get this before you sign up on a plan. Read it and read it again. This document is your friend!! Find out all the places where the insurance company itself spells out these things - what is a pre-existing condition, what is the exclusion period, what constitutes a "significant break" in covereage. It's all in there. And an insurance company's literature WILL BE COMPLIANT with HIPPA if it is a group health plan. It may or may not be compliant with state laws, if the plan is not based in your state. State laws, however, cannot "water down" the protections of HIPPA but can only improve them (allowing 120 days as the definition of a "significant break in coverage" for instance).
Once you have the EOC you can talk back to those really annoying benefits people when they try to feed you their line of bullshit and simply say, for example,
"But the definition of pre-existing condition you just told me conflicts with Section X, paragraph 5, part i which specifically says that pre-existing conditions are only those for which I received medical advice, diagnosis, care, or treatment was recommended or received during the 6 months prior to enrollment in your plan? Which, by the way, is consistent with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). So I'm a little confused. Since we seem to be having a disagreement over interpretation of the law and the Evidence of Coverage, may I request that you consult with someone there and get back to me, in writing, with the actual determination in my case?"
That usually works
Kate