What is a 12 12 pre-existing condition limitation?

Asked by: Anibal Waelchi DDS  |  Last update: January 28, 2024
Score: 4.1/5 (24 votes)

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.

What does the 12 month pre-existing condition limit 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.

What does pre-existing condition limitation mean?

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.

What are declinable pre-existing conditions?

Examples of Declinable Conditions
  • AIDS/HIV.
  • Alcohol abuse/drug abuse with recent treatment.
  • Alzheimer's/dementia.
  • Arthritis, fibromyalgia or other inflammatory joint disease.
  • Cancer (usually in past decade)
  • Cerebral palsy.
  • Congestive heart failure.
  • Coronary artery/heart disease, bypass surgery.

What are the rules for 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.

Can I get around a pre-existing condition limitation in a disability policy?

24 related questions found

Can life insurance deny you for pre-existing conditions?

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.

How 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.

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 is a 3 6 pre-existing condition limitation?

Example: A 3/6 pre-existing clause means that any disabling condition which the Insured received treatment during the 3 months immediately prior to the effective date of coverage is excluded. Once the Insured has been covered for 6 months the pre-existing clause no longer applies.

Does a condition need to be diagnosed to be pre-existing?

A pre-existing condition could be known to the person – for example, if she knows she is pregnant already. People might also apply for coverage when they unknowingly have an undiagnosed condition – for example, tumor cells might be growing within but won't be diagnosed until months or years later.

How far back does pre-existing condition last?

HIPAA did allow insurers to refuse to cover pre-existing medical conditions for up to the first 12 months after enrollment, or 18 months in the case of late enrollment.

Does a pre-existing conditions limitation may not exceed months in all long term care policies?

[Pre-Existing Conditions Limitation: We will not pay for Covered Expenses incurred for any care or confinement that is a result of a Pre-Existing Condition when the care or Confinement occurs within six (6) months following Your initial Certificate Effective Date.

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.

What is preexisting condition limitation 3 12?

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.

What is the maximum time period that pre-existing conditions can be excluded in long term care policies?

A long-term care insurance policy or certificate, other than a policy or certificate that is issued to a group, may not exclude coverage for a loss or confinement that is the result of a preexisting condition unless the loss or confinement begins within six months following the effective date of coverage of an insured ...

How many months can an insurer exclude coverage for a pre-existing condition on a Medicare supplement policy?

Be aware that under federal law, Medigap policy insurers can refuse to cover your prior medical conditions for the first six months.

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.

Does high blood pressure disqualify you from life insurance?

You can still get life insurance with high blood pressure, and your chances of getting the most affordable rates will increase if your condition is being treated. Depending on your blood pressure reading, age, and treatment plan, insurers may even offer you the lowest possible premiums for your demographic.

What blood pressure is too high in pre?

You have gestational hypertension when: You have a systolic blood pressure of 140 mm Hg or higher and/or a diastolic blood pressure of 90 mm Hg or higher. The high blood pressure first happens after 20 weeks of pregnancy.

Is anxiety pre-existing condition for insurance?

Insurance carriers can't deny coverage to any applicant due to a pre-existing condition, including mental illness. They also can't charge higher premiums to individuals with existing health problems.

Does term insurance cover pre-existing conditions?

Pre-existing medical conditions have a impact on your insurance policy application. The insurance provider will ask for you to make a full disclosure of your medical history and obviously details and records of your pre-existing illnesses.

Does sleep apnea affect life insurance?

Yes, you can qualify for life insurance coverage if you have been diagnosed with sleep apnea — as long as you're being actively treated for this condition. The severity of your sleep apnea and other factors, including your height-to-weight ratio, will likely have an impact on your application and premiums.

What are five things not covered by life insurance?

What are five things not covered by life insurance? The five things not covered by life insurance are preexisting conditions, accidents that occur while under the influence of drugs or alcohol, suicide, criminal activity, and death due to a high-risk activity, such as skydiving, and war or acts of terrorism.

What diseases affect life insurance?

Below are examples of chronic conditions that may affect your life insurance eligibility and rates:
  • High cholesterol.
  • Diabetes.
  • Sleep apnea.
  • Depression or anxiety.
  • Alcoholism.
  • Cancer.
  • Digestive diseases.
  • High blood pressure.

What are the reasons for denying a life insurance claim?

Insurers deny the death benefit on life insurance claims for reasons of policy delinquency, material misrepresentation, contestable circumstances and documentation failure.