Is a pre-existing condition a diagnosis?

Asked by: Prof. Lora Kertzmann Jr.  |  Last update: October 24, 2023
Score: 4.7/5 (26 votes)

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

What is the medical term for pre-existing conditions?

Preexisting condition is a term that refers to a known illness, injury, or health condition that existed before someone enrolls in or begins receiving health or life insurance. This includes illnesses such as heart disease, diabetes, cancer, and asthma.

Is a mental health diagnosis a pre-existing condition?

Generally, any mental health illness known to exist before applying for a health insurance policy can be considered a pre-existing condition.

How long is a pre-existing medical condition?

Most insurers count any condition you have had symptoms or treatment for in the past five years as pre-existing, even if it was diagnosed more than five years ago. But some insurers include any conditions you have had treatment for during the past three years or seven years.

What are pre-existing conditions exclusions?

Pre-existing Condition Exclusion. A limitation or exclusion of benefits for a condition based on the fact that you had the condition before your enrollment date in the group health plan.

Pre-Existing Diseases (PED) Explained | Health Insurance Concepts | Pre-Existing Diseases FAQs

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What are 3 pre-existing conditions?

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.

Can a pre-existing medical condition be excluded?

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.

Can insurance deny coverage for preexisting 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. They also can't charge women more than men.

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.

What is the acute onset of pre-existing conditions?

The acute onset of a pre-existing condition is one where you know you have a condition you have been treated for in the past, but then you experience a very sudden, unexpected health issue that came out of nowhere and you need immediate treatment. You must be treated within 24 hours of onset of symptoms.

Is depression and anxiety a preexisting condition?

Health plans you get through your employer that come from major health insurance carriers will also typically consider depression a pre-existing condition.

Is anxiety a pre-existing health 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 counts as a mental illness diagnosis?

Mental illness, also called mental health disorders, refers to a wide range of mental health conditions — disorders that affect your mood, thinking and behavior. Examples of mental illness include depression, anxiety disorders, schizophrenia, eating disorders and addictive behaviors.

What does pre-existing vs existing mean?

And “pre-existing” is not the same as “existing”: “existing” is something which exists, while “pre-existing” is something which has existed earlier than a specific time. The problem is that it's becoming common to mistakenly use “pre-” where it's unnecessary or even incorrect.

What is recurrence of pre-existing condition?

Unexpected Recurrence of a Pre-Existing Condition means a sudden and unexpected outbreak or recurrence of a Pre- Existing Condition which occurs 1) spontaneously and without advance warning either in the form of Physician recommendations or symptoms, is of short duration, is rapidly progressive, and requires urgent and ...

What is the term for existing condition?

On this page you'll find 15 synonyms, antonyms, and words related to existing condition, such as: state of affairs, status, circumstances, existing conditions, how things stand, and no change.

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.

What life insurance won't turn you down?

Guaranteed Issue Whole Life Insurance is a product specially designed with Seniors in mind. If you are between the ages of 50-80, you are guaranteed to be accepted for a policy and cannot be turned down for health or medical reasons.

What are some tips someone can follow if they want insurance and have a pre-existing disease?

7 Tips for Selecting Health Insurance When You Have a Pre-Existing Condition
  • Learn the Health Insurance Basics. ...
  • Audit Your Health Spending. ...
  • Decide on the Type of Insurance Plan You Want. ...
  • Read the Summary Plan Description. ...
  • Take Advantage of a Pre-Tax Healthcare Account. ...
  • Avoid a Lapse in Insurance Coverage.

What is the longest period of time an insurer may exclude coverage for pre-existing conditions in an LTC policy?

Policies covering long term care services may not contain a preexisting condition limitation of more than six months after the effective date of coverage.

Is arthritis a pre-existing condition?

Rheumatoid Arthritis (RA) is a pre-existing medical condition defined as a chronic inflammatory disorder whereby one's own immune system actively attacks one's own tissues.

Which policy covers pre-existing diseases from day 1?

List of Health Insurance Plans Covering Pre-existing Diseases from Day 1
  • Aditya Birla Activ Health Platinum Essential Plan. ...
  • Aditya Birla Activ Health Platinum Enhanced Plan. ...
  • Star Diabetes Safe Insurance Plan. ...
  • Care Supreme Plan with Instant Cover. ...
  • Niva Bupa ReAssure 2.0 Plan with Smart Health+ ...
  • Universal Sompo A Plus Plan.

What are preexisting condition exclusions under Hipaa?

For group health plans, a preexisting condition exclusion is limited to a physical or mental condition for which medical advice, diagnosis, care, or treatment was recommended or received within a maximum of a 6-month period ending on the enrollment date in a plan or policy.

What does 12 months for pre-existing conditions mean?

What is the Waiting Period for Pre-Existing Conditions? Under the Private Health Insurance Act 2007, a health insurer may impose a 12 month waiting period on benefits for hospital treatment for pre-existing conditions.

What is the 3 12 pre-existing condition clause?

The most common pre-ex clauses are 3/12, 6/12 and 12/12. A 3/12 pre-ex means that if you file a claim within the first 12 months the policy is in effect, the insurance company will look back 3 months before the policy took effect to see if it was caused by a pre-existing condition.