What is a 3/12 pre-existing condition?

Asked by: Dudley Wehner MD  |  Last update: July 31, 2023
Score: 4.5/5 (9 votes)

* Coverage is written with a 3/12 pre-existing condition clause. This means that if an insured was treated for a medical condition 3 months prior to their effective date, it will not be covered unless the insured has been insured and still actively at work for 12 months.

What is a 3/12 exclusion?

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.

What does pre-existing condition 12 12 mean?

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 is a 12 month pre-existing condition limitation?

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 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.

Quarantine Corner: Pre-existing Condition Exclusions

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What are examples of pre-existing conditions?

A medical illness or injury that you have before you start a new health care plan may be considered a “pre-existing condition.” Conditions like diabetes, COPD, cancer, and sleep apnea, may be examples of pre-existing health conditions. They tend to be chronic or long-term.

What 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, as well as pregnancy. They cannot limit benefits for that condition either.

How far back does pre-existing condition last?

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'.

Is arthritis a pre-existing condition?

Arthritis is generally considered pre-existing medical condition. This doesn't necessarily mean you can't get travel insurance, but you do need to disclose your condition before you book your cover. With arthritis, you'll need to declare your specific type of arthritis whether it's osteo, rheumatoid, or psoriatic.

How do insurance know about pre-existing conditions?

Full medical cover underwriting

Full underwriting lets you know for sure whether your pre-existing condition is covered or not. You have to provide your insurer with extensive details of your medical history.

Is High Cholesterol a pre-existing condition?

High cholesterol as diagnosed by a physician is considered to be a pre-existing condition by most - if not all - travel insurers.

Does Medicare cover pre-existing conditions?

Medicare defines a pre-existing condition as any health problem that you had prior to the coverage start date for a new insurance plan. If you have Original Medicare or a Medicare Advantage plan, you are generally covered for all Medicare benefits even if you have a pre-existing condition.

What is the usual minimum waiting period for a pre-existing condition under a Medicare?

When it comes to enroll in Medicare Supplement plans with a pre-existing condition, you're may have to wait up to six months before you start receiving coverage.

Can Medigap insurance be denied for pre existing conditions?

Be aware that under federal law, Medigap policy insurers can refuse to cover your prior medical conditions for the first six months. A prior or pre-existing condition is a condition or illness you were diagnosed with or were treated for before new health care coverage began.

Is knee pain a pre-existing condition?

Any conditions, whether it be an illness or injury, that you had prior to the workplace accident is considered a pre-existing medical condition. Some obvious examples of pre-existing injuries include herniated disks, broken bones, shoulder or upper body injuries, knee injuries, and torn ligaments.

Which diseases are not covered in health insurance?

List of Diseases Not Covered Under Health Insurance
  • Congenital Diseases/Genetic Disordered. ...
  • Cosmetic Surgery. ...
  • Health issues due to consumption of drugs, alcohol, and smoking. ...
  • IVF and Infertility Treatments. ...
  • Pregnancy Treatment. ...
  • Voluntary Abortion. ...
  • Pre-existing Illnesses. ...
  • Self-Inflicted injury.

Is depression considered a pre-existing condition?

In health insurance terms, depression is a pre-existing condition if you have seen a provider for it or been diagnosed with it during a specified period of time before you sign up for a new health plan.

What does it mean by pre-existing?

Definition of preexisting

: existing at an earlier time a preexisting medical condition.

What medical conditions do life insurance companies check?

Some of the illnesses that life insurance companies look for include:
  • Heart disease.
  • Asthma.
  • Diabetes.
  • Depression and other mental health concerns.
  • Cancers.
  • Autism.
  • Epilepsy.
  • Obesity.

Is obesity a pre-existing condition for insurance?

Obesity is considered a pre-existing condition under the Affordable Care Act (ACA). So, as with all pre-existing conditions, insurance companies cannot make people with high BMIs pay more in premiums.

What is 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.

Can you be rejected for health insurance?

Residents of California can be denied health insurance coverage for a variety of reasons. You may be denied coverage after reaching a maximum coverage amount due to an illness or treatment.

What is the difference between existing and pre-existing?

A. 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.

Is anxiety considered a pre-existing condition?

Not only do insurers have to offer coverage to people with common pre-existing conditions, like depression or anxiety, plans also have to cover treatment.

Is a cold a pre-existing condition?

What is a pre-existing condition? Well, any health condition that a doctor has previously diagnosed you with prior to your health plan taking effect is considered “preexisting.” This could mean essentially anything, from a simple cold to an active cancer.