How do insurance know about pre existing conditions?

Asked by: Darrell Mills  |  Last update: October 14, 2022
Score: 4.4/5 (59 votes)

Insurers then use your permission to snoop through old records to look for anything that they might be able to use against you. If you have a pre-existing condition, they'll try to deny your claim on the grounds that you were already injured and their insured had nothing to do with it.

Can insurers ask about preexisting 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.

Do pre-existing conditions have to be diagnosed?

A pre-existing condition is a health issue that required diagnosis or treatment prior to an applicants' enrollment in a health plan.

What is a 12 month pre-existing condition limitation?

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.

Is there a time limit on pre-existing conditions?

In California, group health plans can limit or exclude coverage for pre-existing conditions for adults (age 19 and older) for up to six months from the date coverage begins.

Pre-existing Conditions In Health Insurance Explained

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What determines pre-existing condition?

As defined most simply, a pre-existing condition is any health condition that a person has prior to enrolling in health coverage.

What are pre-existing conditions exclusions?

The pre-existing condition exclusion period is a health insurance provision that limits or excludes benefits for a period of time. The determination is based on the policyholder having a medical condition prior to enrolling in a health plan.

Is arthritis a pre-existing condition?

Arthritis is generally considered pre-existing medical condition. This doesn't necessarily mean you can't get travel insurance, but you do need to disclose your condition before you book your cover. With arthritis, you'll need to declare your specific type of arthritis whether it's osteo, rheumatoid, or psoriatic.

What is a 3/12 pre-existing condition?

* Coverage is written with a 3/12 pre-existing condition clause. This means that if an insured was treated for a medical condition 3 months prior to their effective date, it will not be covered unless the insured has been insured and still actively at work for 12 months.

Is high blood pressure considered a pre-existing condition?

High blood pressure (also called hypertension) is a common pre-existing medical condition, and can be covered by your policy - but you need to meet the conditions below.

Is depression considered a pre-existing condition?

In health insurance terms, depression is a pre-existing condition if you have seen a provider for it or been diagnosed with it during a specified period of time before you sign up for a new health plan.

Is high blood pressure considered a preexisting condition for travel insurance?

The quick answer to this question is: yes! You should always tell your insurer about your high blood pressure, even if it's being well-managed through medication. High blood pressure is considered to be a 'pre-existing medical condition' by insurers.

Can insurance companies ask health questions?

Under health reform, health insurance companies can't make you answer health questions to buy health insurance. They also can't require a pre-existing condition waiting period for claims you submit.

Why do insurance companies ask health questions?

Insurers commonly conduct such surveys, known as “health risk assessments,” to help make sure members with specific health needs receive proper treatment, as well as to help predict costs so insurers can accurately set premiums.

What questions are asked on a health insurance application?

Basic Information
  • Employer and income information for you and your family members (taken from pay stubs, W-2 forms, or wage and tax statements)
  • Policy numbers for current health insurance plans.
  • Information about job-related health insurance that's available to you or your family.

Can I be denied health insurance because of a pre-existing 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.

Which diseases are not covered in health insurance?

List of Diseases Not Covered Under Health Insurance
  • Congenital Diseases/Genetic Disordered. ...
  • Cosmetic Surgery. ...
  • Health issues due to consumption of drugs, alcohol, and smoking. ...
  • IVF and Infertility Treatments. ...
  • Pregnancy Treatment. ...
  • Voluntary Abortion. ...
  • Pre-existing Illnesses. ...
  • Self-Inflicted injury.

Is knee pain a pre-existing condition?

Any conditions, whether it be an illness or injury, that you had prior to the workplace accident is considered a pre-existing medical condition. Some obvious examples of pre-existing injuries include herniated disks, broken bones, shoulder or upper body injuries, knee injuries, and torn ligaments.

What is a pre-existing look back period?

The pre-existing look back period for a travel insurance policy is the number of days that the insurance company will “look back” to determine if a claim is related to a pre-existing condition. The look back period is generally between 60 and 180 days, depending on the policy selected.

What medical conditions do you have to declare for travel insurance?

If you've ever had any of the following, you'll always need to declare it on your travel insurance: A cardiovascular condition – including high blood pressure or cholesterol. Any heart condition.
...
  • Symptoms.
  • Treatment/medication.
  • Investigation.
  • Medical appointments.
  • Follow-ups.
  • Check-ups.
  • Surgery.

How can I reduce my waiting period for health insurance?

Some insurance companies offer an option to reduce waiting period by paying additional premium. There is also a common cooling period of waiting period of 1 month for accidental hospitalization or overall any claim to be registered. Hence you may not be able to immediately register a claim post buying a policy.

Can I buy health insurance and use it immediately?

The initial waiting period completely varies from insurer to insurer, however the minimum waiting period is at least 30 days. The only exception in initial waiting period is accidental claims wherein the claims are approved if the insured meets with an accident and requires immediate hospitalisation.

What is the difference between existing and pre-existing?

A. You can use pre- in ways that are redundant, but it's a valid prefix, and preexisting has its own meaning. For instance, if you want to describe dinosaurs in relation to humans, existing doesn't work, but preexisting does.