What do insurance companies consider pre-existing?

Asked by: Bo Hagenes  |  Last update: December 23, 2023
Score: 4.7/5 (57 votes)

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 does insurance consider 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 type of insurance can be denied due to 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. They also can't charge women more than men.

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 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.

Should Insurance Charge You for Your Pre-Existing Condition? | NBC News

29 related questions found

Does high blood pressure make you uninsurable?

If you have high blood pressure, you may be wondering if you can still get life insurance. The answer is yes, but your rates may be higher than someone with normal blood pressure.

What blood pressure is considered pre?

Prehypertension is defined as a systolic pressure from 120–139 millimeters of mercury (mm Hg) or a diastolic pressure from 80–89 mm Hg. Because blood pressure changes often, your health care provider will check it on several different days before deciding whether your blood pressure is too high.

How long do you have to wait for pre-existing conditions?

Pre-existing conditions exclusion

If you have a pre-existing condition when you enroll in health coverage, you may be subject to a pre-existing condition exclusion. This type of waiting period can last a maximum of 12 months, unless you're a late enrollee, in which case it can go up to 18 months.

Is a bad back a pre-existing medical condition?

No matter how serious or mild your back problem is, it is considered a pre-existing medical condition.

What is the 6 24 pre-existing condition exclusion?

A Pre-Existing Condition is excluded from coverage for period of [6-24] months following the Covered Person's Rider Effective Date. If the Covered Person is Diagnosed with a condition listed in this rider that is determined to be a Pre-Existing Condition, no benefit amount is payable for that listed condition.

How do I appeal a pre-existing condition?

If you find yourself in this unfortunate situation, you need to speak with an experienced long-term disability lawyer right away. Your legal representative can help you understand why your claim was denied and take proactive and aggressive steps to file a timely administrative appeal if you have group 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.

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 medical conditions prevent you from getting life insurance?

Life insurance companies base their decisions to approve or deny coverage on risk. So, there is a chance that you may be denied life insurance if you have an illness like heart disease, cancer, diabetes, or HIV/AIDS. You may also be denied if you have a history of mental illness.

Can insurance companies deny coverage?

A car insurance company can deny coverage for almost any reason. An insurer might deny coverage to a driver who it believes poses a higher risk and is more likely to file a claim.

Is UTI a pre-existing condition?

Examples of curable pre-existing conditions include: Respiratory Infections. Urinary Tract/Bladder Infections. Vomiting, Diarrhea, & Other Gastrointestinal Disorders.

Is constant back pain a disability?

If your chronic back pain is preventing you from performing the essential duties of your job, you may qualify for long-term disability (LTD). Chronic back pain is a common symptom. Spine injuries and other medical conditions can cause severe back pain.

What are the common back conditions?

These conditions may include:
  • Tumors.
  • Spinal stenosis.
  • Herniated discs.
  • Abscess.
  • Hematoma.
  • Vertebral fractures.
  • Degenerative disc disease.

What back problems are considered a disability?

To be approved for disability benefits, individuals must match the symptoms outlined there. Qualifying conditions include degenerative disc disease, ankylosing spondylitis, spinal stenosis, and several others.

What determines a pre-existing 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 is a 3 6 pre-existing condition exclusion?

These provisions also include a treatment period, usually 3 months or 6 months, called the “pre-existing period.” This basically means that you cannot have been treated for, or taken prescribed medications 3 months before the effective date of coverage.

What is the time limit for pre-existing conditions prior to someone beginning a Medicare Part B policy?

The pre-existing condition waiting period

“ This means that you may have to pay all your own out-of-pocket costs for your pre-existing condition for up to six months. After the waiting period, the Medicare Supplement insurance plan may cover Medicare out-of-pocket costs relating to the pre-existing condition.

Does caffeine raise blood pressure?

Caffeine may cause a short, but dramatic increase in your blood pressure, even if you don't have high blood pressure.

What stage is 140 90 blood pressure?

Stage 2 high blood pressure is 140/90 or higher. If you get a blood pressure reading of 180/110 or higher more than once, seek medical treatment right away. A reading this high is considered “hypertensive crisis.” Readings between 120/80 and 129/89 are considered pre-hypertension.