What is a pre-existing condition when applying for health insurance? — CoverMe Blog (2024)

FAQs

What is a pre-existing condition when applying for health insurance? — CoverMe Blog? ›

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.

An illness or injury experienced before enrollment in a health insurance plan may be considered a pre-existing condition. Pre-existing conditions can include health issues such as cancer, diabetes, lupus, depression, acne, pregnancy, or just about any other health condition you can imagine.

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.

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. They also can't charge women more than men.

Don't worry; having such a condition will not necessarily prevent you from having coverage. Many of the plans that have a pre-existing condition clause will allow coverage, but only for medical conditions diagnosed after your plan is in effect. The insurance company will decide if they will take you on as a client.

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.

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.

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.

It's in their best interest, therefore, to exclude people with pre-existing conditions (or make the coverage unappealing to them), impose a waiting period before coverage starts, or charge higher premiums and out-of-pocket expenses to cover people with pre-existing conditions since those people are likely to cost the ...

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.

When did pre-existing conditions end? ›

Before 2014, some insurance policies would not cover expenses due to pre-existing conditions. These exclusions by the insurance industry were meant to cope with adverse selection by potential customers. Such exclusions have been prohibited since January 1, 2014, by the Patient Protection and Affordable Care Act.

Examples of Pre-existing Conditions

Arthritis. Cancer. Carpal tunnel syndrome. Depression.

Pre-existing conditions are the medical issues themselves, while the acute onset of pre-existing conditions is the sudden and unexpected recurrence of a pre-existing condition.

Simply put, the Waiver of Pre-Existing Medical Conditions covers, or “waives” the companies right to exclude pre-existing medical conditions from their policy. It's a feature only available with certain comprehensive package plans that include trip cancellation/trip interruption.

After many tests, the ER doctor concludes that you have kidney stones. Usually, kidney stones take approximately 3-4 months to form. This means that it would be considered a pre-existing condition for your plan since your coverage started only 2 days ago.

In some cases, a Medigap insurance company can refuse to cover out‑of‑pocket costs for preexisting health problems for up to 6 months. This is called a “preexisting condition waiting period.” After 6 months, the Medigap policy will cover the preexisting condition.

Before 2014, some insurance policies would not cover expenses due to pre-existing conditions. These exclusions by the insurance industry were meant to cope with adverse selection by potential customers. Such exclusions have been prohibited since January 1, 2014, by the Patient Protection and Affordable Care Act.

People might also apply for coverage when they unknowingly have an undiagnosed condition – for example, tumor cells might be growing within but won't be diagnosed until months or years later. A pre-existing condition might be mild – for example, seasonal allergies or acne treated with simple medications.