What does 3 3 12 pre ex mean?
Asked by: Maximillian Wehner MD | Last update: December 9, 2025Score: 4.1/5 (67 votes)
What does 12 months for pre-existing mean?
What does this mean for me? If your condition has been deemed as pre-existing by our medical practitioner, you'll need to serve the 12-month waiting period (or the remaining part of the period if you have served some of it with your previous fund) before you can claim for the service or treatment.
What is the 3 12 clause?
Pre-Existing Condition Limitation 3/12 - A Pre-Existing Condition is a Sickness or Injury for which you have received treatment within 3 months prior to your effective date. Any disability contributed to or caused by a Pre-Existing Condition within the first 12 months of your effective date will not be covered.
What does pre-existing condition exclusion mean?
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.
How far back do insurance companies look for pre-existing conditions?
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.
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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 does 3/12 mean on disability insurance?
The pre-existing condition under this plan is 3/12 which means any condition that you receive medical attention for in the 3 months prior to your effective date of coverage that results in a disability during the first 12 months of coverage, would not be covered.
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.
How far back 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 Medicare refuse to cover pre-existing conditions?
Yes. Medicare Advantage (MA) plans won't reject your enrollment if you have a preexisting condition.
Can I get disability insurance with a pre-existing condition?
An insurance company will typically (but not always) impose an exclusion for a pre-existing condition, meaning that they will deny your disability claim if you are unable to work due to that pre-existing condition. However, you will still get benefits for any other covered condition.
What is the 12 Necessary and Proper Clause?
[The Congress shall have Power . . . ] To make all Laws which shall be necessary and proper for carrying into Execution the foregoing Powers, and all other Powers vested by this Constitution in the Government of the United States, or in any Department or Officer thereof.
What is the meaning of Clause 3?
No State shall, without the Consent of Congress, lay any Duty of Tonnage, keep Troops, or Ships of War in time of Peace, enter into any Agreement or Compact with another State, or with a foreign Power, or engage in War, unless actually invaded, or in such imminent Danger as will not admit of delay.
How long can a pre-existing medical condition be excluded from a new plan?
Health care reform says that children under age 19 cannot be denied group insurance because of a pre-existing condition. If you are age 19 or older, group health insurance can delay services for your pre-existing condition for up to 6 months.
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.
Is a deviated septum a pre-existing condition?
Most people have a deviated septum that is very mild and doesn't cause any problems. You may be born with a deviated septum or develop it after an injury. Symptoms of a deviated septum include a blocked nose, reduced sense of smell, frequent sinus infections, frequent nosebleeds and obstructive sleep apnoea.
How far back does pre-existing condition last?
A group health plan can count as pre-existing conditions only those conditions for which you actually received (or were recommended to receive) a diagnosis, treatment or medical advice within the 6 months immediately before you joined that plan. This period is known as the “look back” period.
Is anxiety considered 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.
Is a bad back a pre-existing medical condition?
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.
What does a pre-existing condition limitation not apply?
Insurers in some states could have restrictions added on whether they can include a pre-existing condition exclusion period. Today, insurers cannot deny coverage to somebody based on pre-existing conditions, nor charge more.
How long is a pre-existing medical condition?
The insurer will only tell you if you're covered at the time you make a claim. They won't cover you for any conditions you've had in the five years before you took out the insurance. But if you've not had treatment, medication or advice for those conditions for two years, they may cover you for them in the future.
What is the usual minimum waiting period for a pre-existing condition?
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.
What does 100% disability look like?
A 100% VA Disability Rating can be given for a single severe condition or for a group of conditions whose ratings can be combined using VA Math to equal 100%. A 100% VA Disability Rating is commonly given to veterans who have two or more limbs paralyzed or amputated, or for active diseases, like tuberculosis or cancer.
What is a normal disability check?
How much do disability benefits pay? SSDI pays up to $3,822 per month in 2024, but the average SSDI check is around $1,500. Your exact check is based on your income and tax history.
At what age does long-term disability end?
Benefits from group long-term disability policies generally continue until either age 65 or your retirement age under Social Security, or until you are able to return to work. In some policies, benefits may also be available for a period of time after you return to work.