What is a 12 month pre-existing condition limitation?

Asked by: Michael Cummings  |  Last update: February 11, 2022
Score: 4.3/5 (40 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 a pre-existing condition limitation?

A pre-existing condition exclusion period limits the number of benefits that an insurer has to provide for specific medical conditions and does not apply to medical benefits afforded by a health insurance policy for other types of care.

How long can pre-existing conditions be excluded?

A pre-existing condition exclusion can not be longer than 12 months from your enrollment date (18 months for a late enrollee).

What does pre-existing condition exclusion mean?

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").

What does pre-existing limitation 3/12 mean?

A 3/12 means that the policy will not cover any disabilities during the first 12 months after the covered person's effective date of insurance that is caused or contributed by any sickness or injury for which the covered person sought treatment during the three months prior to the effective date of coverage.


41 related questions found

Is pregnancy a pre-existing condition STD?

Individual STD policies require medical underwriting, and pre-existing conditions are typically excluded. If you apply during your pregnancy, it will be considered a pre-existing condition. While the insurance company may write the policy, any disability or claim relating to pregnancy will likely be excluded.

What is a 3 6 pre-existing condition?

The pre-existing condition under this plan is 3/6 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 6 months of coverage, would not be covered.

How does pre-existing conditions work?

How are pre-existing conditions determined? A pre-existing condition is typically one for which you have received treatment or diagnosis before you enrolled in a new health plan. ... The ACA made it illegal for health insurance companies to deny you medical coverage or raise rates due to a pre-existing condition.

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

How do insurance companies know if you have a pre-existing condition? Life insurance applications ask questions about your health, and the process typically requires you to give the insurer permission to access any medical records needed to validate your information.

What is meant by pre-existing disease?

A pre-existing illness means any health issue that the proposer has been facing prior to purchasing a health insurance policy. The pre-existing conditions include all the health issues ranging from high blood pressure, thyroid, the usual suspects like diabetes, asthma, etc.

Which pre-existing conditions are not covered?

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. They cannot limit benefits for that condition either. Once you have insurance, they can't refuse to cover treatment for your pre-existing condition.

Are pre-existing conditions covered in 2021?

Yes. 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.

How long does pre-existing last?

A health condition could be considered pre-existing if you received treatment or medical advice for that issue from six months to five years before the insurance coverage took effect. The time varied by state.

What are pre-existing conditions list?

What is a pre-existing condition?
  • Cancer.
  • Cerebral palsy.
  • Depression and other mental health disorders.
  • Dementia and Alzheimer's.
  • Diabetes.
  • Epilepsy.
  • Gender dysphoria.

Is high blood pressure considered a pre-existing condition?

Other Types of Pre-existing Conditions

Hypertension (high blood pressure) is an example of one such common pre-existing condition affecting more than 33 million adults under 65.

Is back pain considered a pre-existing condition?

In essence, they're medical conditions that existed before your policy started. Some of the commonly understandable pre-existing conditions can be chronic illnesses like diabetes, high blood pressure, asthma etc. The pre-existing conditions can include chronic injuries like back pain too.

Can I get private health insurance with a pre-existing condition?

Can I get health insurance with a pre-existing condition? Yes, you can still get health cover if you have a pre-existing condition.

Can you be denied disability if pregnant?

You may obtain short-term disability insurance during your pregnancy but the insurer may be able to decline coverage. If the insurer declines coverage it will often be because it has considered your pregnancy a pre-existing condition.

Can pregnancy be considered short-term disability?

Women can qualify for short-term disability while pregnant. Short-term disability insurance can cover part of your income while you are out of work due to pregnancy and birth. And pregnancy is one of the most common causes of short-term disability leave.

Can I get disability for high risk pregnancy?

Under the federal Americans with Disabilities Act (“ADA”), if you work for an employer with 15 or more employees and have a pregnancy-related disability, which may include examples such as a high-risk pregnancy, gestational diabetes, or preeclampsia and that disability substantially limits a major life activity you may ...

Is the Affordable Care Act still in effect?

The Rest of the ACA Remains in Effect

Other than the individual mandate penalty repeal (and the repeal of a few of the ACA's taxes, including the Cadillac Tax), the ACA is still fully in effect.

What is the difference between existing and pre-existing?

You can use pre- in ways that are redundant, but it's a valid prefix, and preexisting has its own meaning. For instance, if you want to describe dinosaurs in relation to humans, existing doesn't work, but preexisting does.

What is an example of pre?

Pre is defined as something that happens before the next word. An example of the pre prefix is preschool or school you attend before you officially start school. An example of the pre prefix is preheat, or to heat an oven before you put something in to cook. (slang) Precum, Cowper's fluid, pre-ejaculate.