What is a 3 3 12 pre-existing condition?

Asked by: Dr. Donny Weimann  |  Last update: December 5, 2023
Score: 5/5 (30 votes)

(Number of Months Look Back Period) / (Number of Months Look Back Applies) 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 does 3 3 12 pre ex mean?

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 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 is the 3 6 12 pre-existing clause?

Pre-Existing Condition: 3/6/12 Rule: If you are treated for a medical condition 3 months prior to your effective date, it will not be covered unless you are treatment free for 6 consecutive months after your effective date of coverage or after you have been insured and still active at work for 12 consecutive months.

What are 3 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, chronic obstructive pulmonary disease (COPD), cancer, and sleep apnea, may be examples of pre-existing health conditions. They tend to be chronic or long-term.

What are pre-existing conditions? - Can pre-existing conditions be denied?

45 related questions found

What is a 3 6 pre-existing condition?

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.

What is considered a pre-existing illness?

A health problem, like asthma, diabetes, or cancer, you had before the date that new health coverage starts.

Which circumstance requires the pre-existing condition clause?

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 does pre-existing vs existing mean?

And “pre-existing” is not the same as “existing”: “existing” is something which exists, while “pre-existing” is something which has existed earlier than a specific time. The problem is that it's becoming common to mistakenly use “pre-” where it's unnecessary or even incorrect.

What does pre-existing plans mean?

The Affordable Care Act created the Pre-Existing Condition Insurance Plan (PCIP) to make health insurance available to those that have been denied coverage by private insurance companies because of a pre-existing condition.

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.

Can I be denied coverage for a pre-existing condition?

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.

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.

Does a pre-existing condition affect long-term disability?

As a cost-savings mechanism, most long-term disability plans exclude pre-existing conditions. While the definition will vary from plan to plan, pre-existing conditions usually include any chronic physical, mental, or emotional condition that you have been treated for shortly before you obtained coverage.

What are three examples of pre-existing conditions that may be written into a disability contract as exclusions?

What Does Pre-Existing Mean?
  • Example One: Herniated Disc as a Result of a Car Accident. So, let's use an example within the long-term disability world. ...
  • Example Two: Chronic Obstructive Pulmonary Disorder (COPD) Let's change the circumstances a little bit. ...
  • Example Three: Heart Attack.

What is the 6 24 pre-existing condition exclusion?

A Pre-Existing Condition is excluded from coverage for period of [6-24] months following the Covered Person's Rider Effective Date. If the Covered Person is Diagnosed with a condition listed in this rider that is determined to be a Pre-Existing Condition, no benefit amount is payable for that listed condition.

What is long term pre-existing?

Pre-Existing Condition Limitations

A long-term care insurance policy usually defines a pre-existing condition as one for which you received medical advice or treatment or had symptoms within a certain period before you applied for the policy. Some companies look further back in time than others.

What is a sentence with pre-existing?

How to use pre-existing in a sentence. Patients with preexisting medical conditions like diabetes drive health spending. He has health insurance and, as far as we know, no preexisting conditions. Or at least, they like coverage for their kids, health-care rebates and a ban on denying coverage for preexisting conditions ...

What does it mean to just be existing?

It's lacking the true essence and meaning of life. Existing simply means to survive without feeling the actual reality of the feelings and emotions in it. You may either be living in the past or the future, but only existing in the present, passing away rapidly.

What is an example of existing condition?

A pre-existing condition might be mild – for example, seasonal allergies or acne treated with simple medications. Or it could be more serious or require more costly treatment – such as diabetes, heart disease, or cancer.

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 some tips someone can follow if they want insurance and have a pre-existing disease?

7 Tips for Selecting Health Insurance When You Have a Pre-Existing Condition
  • Learn the Health Insurance Basics. ...
  • Audit Your Health Spending. ...
  • Decide on the Type of Insurance Plan You Want. ...
  • Read the Summary Plan Description. ...
  • Take Advantage of a Pre-Tax Healthcare Account. ...
  • Avoid a Lapse in Insurance Coverage.

Is a pre-existing condition a diagnosis?

A pre-existing condition is a health issue that required diagnosis or treatment prior to an applicants' enrollment in a health plan.

Can health insurance drop you?

Insurers can rescind your policy if you intentionally misrepresent material facts on your application. Insurers can cancel your policy if you do not pay your premium. However, you have a 30 day grace period before insurers can cancel your policy.

Is a mental health diagnosis a pre-existing condition?

Generally, any mental health illness known to exist before applying for a health insurance policy can be considered a pre-existing condition.