What does 12 months for pre-existing mean?

Asked by: Percy Pagac  |  Last update: May 10, 2025
Score: 4.6/5 (1 votes)

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 12 month waiting period for pre-existing conditions?

A pre-existing condition exclusion can not be longer than 12 months from your enrollment date (18 months for a late enrollee). A pre-existing condition exclusion that is applied to you must be reduced by the prior creditable coverage you have that was not interrupted by a significant break in coverage.

How long is something considered a pre-existing condition?

Any condition (either physical or mental) including a disability for which medical advice, diagnosis, care, or treatment was recommended or received within the 6-month period ending on your enrollment date in a health insurance plan.

How long ago 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'.

Can I get life insurance if I have a pre-existing condition?

Yes, life insurance is available with preexisting conditions. Keep in mind that some companies do better than others with certain medical conditions, so it is best to work with someone who understands high-risk medical conditions, is an independen...

What is a Pre existing Condition ?

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What pre-existing conditions are not covered?

Is there health insurance for pre-existing conditions? Choosing a health plan is no longer based on the concept of a pre-existing condition. A health insurer cannot deny you coverage or raise rates for plans if you have a medical condition at the time of enrollment.

What will disqualify me from life insurance?

A few common examples of pre-existing conditions include high blood pressure, diabetes, cancer, and asthma. Previous injuries might be considered pre-existing conditions, depending on their severity and any lasting effects.

What counts as a pre-existing condition?

A pre-existing condition is any condition you had before your policy started. A chronic condition is something that is on-going and that has no known cure. Asthma, arthritis and diabetes are examples of chronic conditions. Most health insurance doesn't cover pre-existing or chronic conditions.

What is an example of a pre-existing condition?

Insurers generally define what constitutes a pre-existing condition. Some are obvious, like currently having heart disease or cancer. Others are less so – such has having asthma or high blood pressure.

How do insurance companies know if you have a pre-existing condition?

To determine if a condition is pre-existing, insurers examine medical history, treatment records, and diagnosis reports. They may use “look-back periods,” which are specific timeframes—typically six months to a year before coverage begins—to review medical history.

What is a 12 12 pre-existing condition limitation?

A 12/12 pre-existing condition means that if you have a claim in the first twelve months, the insurance company will look back 12 months before you started the policy to see if you had a pre-existing condition that might have caused it. You'll find the most common pre-exes are 3/12, 6/6, 6/12 and 12/12.

Does life cover pre-existing conditions?

Yes, you can still get life insurance with existing medical conditions. It may cost more, depending on the health issues you have. Insurers are likely to view people with pre-existing conditions as higher risk when providing cover.

What is the pre-existing condition review period?

Most travel insurance providers impose a lookback period to verify if a claim is relating to a pre-existing medical condition. A lookback period is a time-frame, which typically ranges from 60-180 days, in which a provider can review your medical records and history.

How long is a condition considered pre-existing?

The length of time before the start date of coverage during which a condition would be considered pre-existing varies, and can be anywhere from 30 days to 6 months or longer.

How soon after getting insurance can you get surgery?

Depending on your provider, insurance companies can take anywhere between 1-30 days to approve the request. Stay in communication with your care team, as timing for approval varies between insurance providers.

Is anxiety 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.

Can you be denied life insurance for a pre-existing condition?

Depending on the situation, a pre-existing health condition might cause an early or unexpected death, which increases the risk for the insurer. As a result, the cost of the policy is higher. If the risk is too high, the insurer may deny coverage altogether.

What is the waiting period for pre-existing diseases?

Almost all health insurance plans cover pre-existing diseases after a waiting period of usually 2 to 3 years. This implies that any hospitalization expenses related to the declared ailments can be claimed only after 2 to 3 successful years with the insurer.

What is an example of a pre condition?

It's the thing that has to happen before something else happens. For example, as a precondition to getting your allowance, you might have to give the dog a hairdo once a week. Precondition is often used in the negative – when world leaders meet to discuss something, they might ask for no preconditions.

What makes a condition pre-existing?

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.

Is acid reflux considered a pre-existing condition?

Is reflux really a pre-existing medical condition? The simple answer is yes.

Is high cholesterol considered a pre-existing condition?

Does high cholesterol count as a pre-existing medical condition? Yes. High cholesterol is considered a pre-existing medical condition by insurance companies, along with similar conditions like high blood pressure.

How to get life insurance with pre-existing condition?

Tips to increase your chances of getting life insurance with pre-existing conditions
  1. Stick to your treatment plan. ...
  2. Get regular exercise. ...
  3. Lose weight. ...
  4. Compare quotes. ...
  5. Re-apply after your condition improves. ...
  6. Appeal the decision. ...
  7. Work with an insurance broker. ...
  8. Explore guaranteed issue life insurance.

What reasons will life insurance not pay?

17 Common Reasons Life Insurance Won't Pay Out
  • Nonpayment of Premiums.
  • Death during the Contestability Period.
  • Misrepresentation on Application.
  • Employer Failed to Submit a Disability Waiver of Premium.
  • Problems with the Beneficiary.
  • Policy was included in a Trust or a Will.
  • Denials Due to Suicide Exclusion.

Is high blood pressure a pre-existing condition?

What is a preexisting condition? Preexisting conditions are health problems you had before applying for or enrolling in a new insurance plan. Some can be chronic diseases, such as diabetes, high blood pressure or cancer.