Pre-existing condition - Glossary (2024)

We take your privacy seriously. You can change the settings for each category to choose how we collect and use information while you’re on HealthCare.gov. For details, review our full privacy policy or get the list of specific tools in each category.

CategoryDescriptionStatus
AdvertisingWe use digital advertising tools, such as web beacons, to track the effectiveness of our digital advertising outreach efforts. This helps us identify ads that are helpful to consumers and efficient for outreach. Select “Don’t allow” to block this tracking.
Advertising

Social MediaIf you share our content on Facebook, Twitter, or other social media accounts, we may track what HealthCare.gov content you share. This helps us improve our social media outreach. Select “Don’t allow” to block this tracking.
Social Media

Web AnalyticsWe use a variety of tools to count, track, and analyze visits to HealthCare.gov. This helps us understand how people use the site and where we should make improvements. Select “Don’t allow” to block this tracking.
Web Analytics

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 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.

How to 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.

What counts as pre-existing medical conditions? ›

What are pre-existing medical conditions? 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.

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.

How far back is a pre-existing condition? ›

A pre-existing medical condition is a disease, illness or injury for which you have received medication, advice or treatment or had any symptoms (whether the condition has been diagnosed or not) in the five years before your joining date. Health insurance doesn't usually cover 'pre-existing conditions'.

How long can a pre-existing condition be excluded? ›

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.

What is the preexisting condition limitation? ›

A pre-existing condition exclusion period limits the number of benefits that an insurer has to provide for specific medical conditions and does not apply to medical benefits afforded by a health insurance policy for other types of care.

Is high blood pressure 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 a pre-existing medical 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.

Does arthritis count as a pre-existing condition? ›

In general, health insurance companies consider the following illnesses and conditions to be pre existing conditions: Asthma and other chronic respiratory conditions. Diabetes. Arthritis.

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

A pre-existing condition is an injury, disease, or surgery that predates your disability insurance policy. Your disability insurance claim may be denied if the injury or illness that's keeping you out of work is tied to a pre-existing condition.

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).

Top Articles
Latest Posts
Article information

Author: Chrissy Homenick

Last Updated:

Views: 5533

Rating: 4.3 / 5 (74 voted)

Reviews: 89% of readers found this page helpful

Author information

Name: Chrissy Homenick

Birthday: 2001-10-22

Address: 611 Kuhn Oval, Feltonbury, NY 02783-3818

Phone: +96619177651654

Job: Mining Representative

Hobby: amateur radio, Sculling, Knife making, Gardening, Watching movies, Gunsmithing, Video gaming

Introduction: My name is Chrissy Homenick, I am a tender, funny, determined, tender, glorious, fancy, enthusiastic person who loves writing and wants to share my knowledge and understanding with you.