Pre-existing condition - Glossary (2024)

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Pre-existing condition - Glossary (2024)

FAQs

Can you be denied for pre-existing conditions? ›

Under the Affordable Care Act, health insurance companies can't refuse to cover you or charge you more just because you have a “pre-existing condition” — that is, a health problem you had before the date that new health coverage starts.

What qualifies as a preexisting condition? ›

A health problem, like asthma, diabetes, or cancer, you had before the date that new health coverage starts. Insurance companies can't refuse to cover treatment for your pre-existing condition or charge you more.

What counts as a pre-existing condition? ›

A pre-existing medical condition (PEMC) is an illness or injury you had before your policy began or was renewed. Examples of pre-existing medical conditions include, diabetes, asthma, high cholesterol or a long-term back condition.

How do you avoid pre-existing condition exclusion? ›

If your health plan is fully compliant with the ACA and obtained in either the individual/family market or the employer-sponsored market, you no longer need to worry about pre-existing condition exclusion periods.

Is a bad back a pre-existing medical condition? ›

Is back pain a pre-existing medical condition? Yes.

What if pre-existing conditions are not declared? ›

Failure to disclose pre-existing conditions not only jeopardizes the chances of successful claims but may also lead to the cancellation of the policy in extreme cases.

Is high blood pressure considered a pre-existing condition? ›

A few common examples of pre-existing conditions include high blood pressure, diabetes, cancer, and asthma. Previous injuries might be considered pre-existing conditions, depending on their severity and any lasting effects.

What is pre-existing condition waiver? ›

What is the Waiver of Pre-Existing Medical Conditions in Travel Insurance? Simply put, the Waiver of Pre-Existing Medical Conditions covers, or “waives” the companies right to exclude pre-existing medical conditions from their policy.

How long can an insurer exclude coverage for a pre-existing condition? ›

The time period during which a health plan won't pay for care relating to a pre-existing condition. Under a job-based plan, this cannot exceed 12 months for a regular enrollee or 18 months for a late-enrollee.

How long ago is a pre-existing condition? ›

It applies to any medical condition that you saw your doctor about the five years before the start date on your health insurance. For example, you might take out a policy and then go and see your GP about some back pain you've been experiencing.

Is high cholesterol considered a pre-existing condition? ›

In the health insurance world, a pre-existing condition is any injury, sickness or condition that exists before the date an insurance policy takes effect. Examples include asthma, diabetes, anxiety, depression, high blood pressure, high cholesterol and so on.

What is the difference between existing and preexisting? ›

Existing is a certain thing that is present nowadays and can be seen in present time. Preexisting refers to something that has existed a long time ago, and forgotten, and has existed once more in our present time.

Can you still be denied for pre-existing conditions? ›

Health insurers can no longer charge more or deny coverage to you or your child because of a pre-existing health condition like asthma, diabetes, or cancer, as well as pregnancy. They cannot limit benefits for that condition either.

What determines a pre-existing condition? ›

A medical illness or injury that you have before you start a new health care plan may be considered a pre-existing condition. Conditions like diabetes, chronic obstructive pulmonary disease (COPD), cancer, and sleep apnea, may be examples of pre-existing health conditions. They tend to be chronic or long-term.

What is the preexisting condition limitation? ›

The time period during which an individual policy won't pay for care relating to a pre-existing condition. Under an individual policy, conditions may be excluded permanently (known as an "exclusionary rider").

Can disability insurance be denied for pre-existing conditions? ›

If it finds any evidence that your illness or injury was previously diagnosed, it will deny your claim. This is true for both short and long-term disability insurance, but even with a pre-existing condition you can still receive benefits for unrelated illnesses or injuries.

What is a waiting period for a pre-existing condition? ›

The time period during which a health plan won't pay for care relating to a pre-existing condition. Under a job-based plan, this cannot exceed 12 months for a regular enrollee or 18 months for a late-enrollee.

Do pre-existing conditions affect life insurance? ›

Due to the added risk health problems create for insurers, some pre-existing conditions can raise your premium or even disqualify you entirely from certain types of life insurance. A few common examples of pre-existing conditions include high blood pressure, diabetes, cancer, and asthma.

Can employers ask about pre-existing conditions? ›

The ADA places restrictions on employers when it comes to asking job applicants to answer medical questions, take a medical exam, or identify a disability. An employer may not ask a job applicant, for example, if he or she has a disability (or about the nature of an obvious disability).

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