What does a preexisting condition exclusion in an accident and health insurance policy pertain to?
Asked by: Preston Mante Jr. | Last update: January 9, 2026Score: 4.9/5 (41 votes)
What is pre-existing condition exclusion?
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 do health insurance companies consider pre-existing conditions?
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.
Can an insurer exclude coverage for a preexisting condition?
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. They cannot limit benefits for that condition either.
What is the standard pre-existing condition exclusion period for most critical illness insurance policies?
The plan was allowed to look back at the previous six months of the person's medical history and exclude pre-existing conditions that were treated during that six months, with the exclusion period lasting no more than 12 months.
What Are Pre-Existing Medical Conditions?
What is a pre-existing condition exclusion in an accident?
A pre-existing condition exclusion waiting period is the length of time after the start date of an insurance policy that a person must wait before any pre-existing conditions are covered. The waiting period is often longer for individually purchased policies.
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.
What type of insurance can be denied due to pre-existing conditions?
Coverage for pre-existing conditions
All Marketplace plans must cover treatment for pre-existing medical conditions. No insurance plan can reject you, charge you more, or refuse to pay for essential health benefits for any condition you had before your coverage started.
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'.
Will my new insurance cover an old medical bill?
Conclusion: Will My Insurance Cover an Old Medical Bill? Your insurance will only cover an old medical bill if that insurance was in effect on the date medical services were provided. If you did not have health insurance in effect on the date of service, any new insurance won't pay for that old medical bill.
Do any insurers cover pre-existing conditions?
In some cases, you'll also need to give the insurer access to your medical records. The insurer can then decide if they want to insure you or not for a pre-existing condition. So, you may be able to get insurance for a pre-existing medical condition that is excluded with Moratorium underwriting.
What type of injury would not be covered under a health insurance policy?
The type of injury that would NOT be covered under a health insurance policy is a recreational injury. Health insurance policies generally cover accidental injuries, work-related injuries, and sports-related injuries. Accidental injuries can occur in everyday situations, like slipping and falling.
How long can an insurer exclude coverage for a pre-existing condition on a medicare supplement?
In some cases, the Medigap insurance company can refuse to cover your out of pocket costs for these pre‑existing health problems for up to 6 months. This is called a “pre‑existing condition waiting period.” After 6 months, the Medigap policy will cover the pre‑existing condition.
What is condition exclusion?
With condition exclusion the system automatically compares conditions in sales documents and billing documents, determines the most appropriate price for a customer, and excludes unsuitable conditions.
Can insurance decline 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.
What does exclusion mean in health insurance?
Insurance exclusions are provisions in an insurance policy specifying risks that are not covered. Whether the policy is written for home, renters, health, automobile or business insurance, exclusions allow the insurance company to define when your coverage applies – and when it does not.
What is the exclusion 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).
What counts as a pre-existing condition?
A “pre-existing condition” is a health condition that exists before someone applies for or enrolls in a new health insurance policy. Insurers generally define what constitutes a pre-existing condition. Some are obvious, like currently having heart disease or cancer.
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.
Is high cholesterol 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.
What life insurance is best for pre-existing conditions?
People with pre-existing conditions have several life insurance options: Term life insurance: Term life insurance policies have more favorable premiums and large death benefits, but coverage only lasts 10 to 30 years. This policy may be right for you if you'd like the most coverage for your budget.
Can I be denied health insurance because of a pre-existing condition reddit?
It's been over a decade. Obamacare got rid of the pre-existing conditions and a bunch of other things. It also created a marketplace where people who don't get insurance through their employer can buy insurance that meets the requirements of the law (we say that it's ACA-compliant).
What is a pre-existing condition exclusion waiver?
What is the Waiver of Pre-Existing Medical Conditions in Travel Insurance? Simply put, the Waiver of Pre-Existing Medical Conditions covers, or “waives” the companies right to exclude pre-existing medical conditions from their policy.
What is the exclusion period?
The time period during which an individual policy won't pay for care relating to a pre-existing condition. Under an individual policy, conditions may be excluded permanently (known as an "exclusionary rider"). Rules on pre-existing condition exclusion periods in individual policies vary widely by state.
How far back do health insurance companies check medical records?
How long are medical records kept? The answer varies depending on the state. In California, the retention period can be anywhere from two to ten years, depending on the type of procedure or healthcare provider. However, an insurance claim medical report should only look as far back as the injury in question.