Pre-Existing Conditions

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In Health Insurance, the term "Pre-Existing Conditions" has various meanings, in separate contexts, such as:

• General use of the term "Pre-Existing Condition - it refers to a medical condition that existed before one applied for an Insurance Plan. 
• Specific, narrowly defined clauses in the Insurance Contract - An Insurance Company will very narrowly, and very specifically define a Pre-Existing Condition in two situations:
• Underwriting - when you apply for an Insurance plan, and you are asked to disclose medical conditions on the application.
• Pre-Existing Conditions Waiting Period - the clause that states how long you must be Insured before the Pre-Existing Condition is covered.
  • Definition of "Pre-Existing Conditions"
    • In both situations, the definition of a Pre-Existing Condition will be clearly defined.  For instance, it is common to see wording such as, "a condition for which you had medical treatment (including medications), diagnosis or consultation with a medical professional".  
    • In both situations, the definition of a Pre-Existing Condition will include a "look-back" period (for instance a condition from the last 12 months).
  • Waiting periods for Pre-Existing conditions vary by plan.  Some do not have waiting periods, and others give exceptions to the waiting period.  Always read the definitions carefully.  

If you have a medical condition, it is very important that you learn about Underwriting, Pre-Existing Conditions Waiting Periods, and other options, such as HIPAA Portability rights, COBRA rights, etc.  Please see the Guide for the Uninsured, and those having difficulty obtaining health insurance.

Last updated 2/2/2007