Associations are professional groups, clubs, unions or established organizations. Association-affiliated health coverage can be through group or individual coverage. Association-affiliated health coverage is offered to members of the organization as long as they meet membership and eligibility requirements.

In California, coverage may be marketed and available through individual polices or group policies. When you have a pre-existing medical condition, it is critical to know whether the association is offering you enrollment in individual or group health coverage. Association-affiliated group coverage allows you to enroll with pre-existing medical conditions. However, eligibility for individual coverage through an association may depend on your current health conditions and your medical history for the last ten years.

You are able to obtain this coverage by becoming a member and remaining in good standing of an association, professional group, club, union or the established organization that offers this coverage to its members.

You must meet that organization's eligibility requirements. Some groups only require you to pay dues to remain eligible. Others require certain earnings or work hour minimums. For example, the Screen Actors Guild offers group health coverage; to become eligible, its members must earn a specified income annually.

This depends on the requirements of the association. Some association health coverage allows you to become eligible the day your membership is accepted or approved. Some may let you enroll when you join, however, coverage will not begin until a service wait has been met. Other associations may require you to meet certain conditions before the policy is offered.

Medical underwriting is a detailed process to determine eligibility for coverage that can include physical exams, medical tests, and a review of your previous ten years of medical history.

Your health coverage begins at the same time it begins for other associate members, even if you have a pre-existing condition. The pre-existing condition exclusionary period is a specified period of time from the start of coverage during which the policy will not cover a pre-existing medical condition. The pre-existing condition will typically be covered once that specified time has passed. If you have had previous health coverage within the last 63 days, the Health Insurance Portability and Accountability Act (HIPAA) provisions may exempt you from a pre-existing exclusionary period.

Yes. Previous coverage can be used as credit to reduce pre-existing condition exclusionary periods. The federal Health Insurance Portability and Accountability Act (HIPAA) states that any health coverage, including Medi-Cal (Medicaid) or Medicare, reduces or eliminates pre-existing condition exclusionary periods. This happens when you have had previous health coverage within the last 63 days. That health coverage will reduce month for month the pre-existing condition exclusionary period.

Health Maintenance Organizations (HMO) – None in California

Preferred Provider Organizations (PPO) – 6 months in California

Point of Service (POS) – 6 months in California

Indemnity Plans – 6 months in California

Self Insured Trust – 12 months nationally

This depends on the association-affiliated plan. Some plans provide prescription coverage as a part of the health plan. In some situations prescription drug coverage will be a separate plan. There also may be limits on the prescription drug costs covered annually. Make sure that you thoroughly understand these provisions before selecting your coverage.

That depends upon what coverage is offered and what the association requires in terms of eligibility and premium payments. You may be responsible for all of the cost, a percentage of the cost, or in some cases no cost. This is determined by the association and the agreements with their insurance companies.

You will need to continue to meet the association’s membership requirements. This may only entail remaining a member in good standing. There may be earnings or work hour minimums required to maintain membership and to retain benefits. If you have not been able to continue your membership or to meet the eligibility requirements you may lose this coverage. State or federal health coverage protections, such as COBRA, OBRA and Cal-COBRA do not apply to association-affiliated group health coverage.

No. Association-affiliated private group and individual health insurance policies are not governed by any state or federal laws that stipulate financial eligibility requirements.

Yes. In most cases, being eligible for coverage through Medi-Cal or Medicare does not make you ineligible for association-affiliated group health coverage. Nor does association-affiliated group health coverage affect your eligibility for Medi-Cal and Medicare. Combined coverage can improve the quality of your health coverage.

No. Immigration rules that should be considered relate to your legal residency status and whether you are legally authorized to work in California.

A pre-existing condition should not affect your eligibility for health coverage as long as you continue to meet the association’s requirements for benefits, such as remaining a member in good standing, maintaining earnings or working the minimum number of hours.

Some may offer dental, vision, long term care coverage, long term disability insurance, life insurance and individual health coverage. Depending on eligibility requirements, these benefits may complement your needs. Each benefit plan determines how it interacts with any other public or private coverage.

Health coverage rules can change periodically. Public health coverage (Medi-Cal and Medicare) and how it interacts with your association-affiliated health coverage is an area where the rules change often. Some community based organizations have benefits planners and benefits counselors who are beginning to have expertise on using public and private benefits.