What is a long-term pre-existing condition?

Asked by: Prof. Issac Hintz  |  Last update: January 24, 2024
Score: 4.7/5 (44 votes)

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 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.

How long does a pre-existing condition last?

Most insurers count any condition you have had symptoms or treatment for in the past five years as pre-existing, even if it was diagnosed more than five years ago. But some insurers include any conditions you have had treatment for during the past three years or seven years.

What does 12 months for pre-existing conditions mean?

What is the Waiting Period for Pre-Existing Conditions? Under the Private Health Insurance Act 2007, a health insurer may impose a 12 month waiting period on benefits for hospital treatment for pre-existing conditions.

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.

Bupa By You health insurance | Understanding pre-existing conditions

36 related questions found

What are the cons of long term disability?

Cons:
  • Disability insurance can be expensive. Coverage costs more the older you get or the more dangerous your job is. ...
  • Policies can come with exclusions that don't cover pre-existing conditions. ...
  • Waiting period. ...
  • If you never experience a disability, you won't receive benefits.

What is the most common cause of permanent and long term disability?

Arthritis and other musculoskeletal problems. These are the most common causes of long-term disability. They make up as much as a third of all disability cases.

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 determines a pre-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.

How does pre-existing conditions work?

Health insurance companies cannot refuse coverage 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.

What is the look back period for pre-existing conditions?

What is a pre-existing medical condition? These 60 to 180 days prior to purchase are known as a lookback period and indicate the number of days an insurance company is allowed to look back at your medical records to determine if your claim is related to a pre-existing medical condition.

Is pre-existing the same as already existing?

If something's preexisting, it was already there — it existed earlier. Someone might offer you a babysitting job, but if you have a preexisting agreement to watch your little brother that night, you'll have to turn it down.

Is high blood pressure 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 are 4 examples of long-term insurance?

Long-term insurance policies include policies like funeral cover, life insurance, disability cover and income protection. These policies are taken out for a much longer period, usually at least five years but often for as long as 20 or 30 years, or more.

How long does a long-term plan last?

Long-term planning involves goals that take a longer time to reach and require more steps; they usually take a minimum of a year or two to complete.

What are examples of long-term insurance?

This is called long-term insurance. For example: Health policies, Life and disability cover. This covers your motor vehicle for damage, theft, and damage caused to property belonging to other parties. This covers your household contents, for example furniture, appliances and personal belongings.

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.

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.

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.

Does insurance cover pre-existing conditions?

You can still get health insurance cover if you have pre-existing medical conditions, but it is unlikely your policy will provide cover for them. The type of underwriting of your health plan determines whether your pre-existing conditions will be covered in the future.

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.

What is the 3 12 pre-existing condition clause?

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 number 1 cause of disability?

In the United States, pain, depression, and anxiety are among the most common causes of years lived with disability (YLD). disorders, autism spectrum disorder, ADHD, conduct disorder, and other mental and substance abuse.

What is the 5 year rule for Social Security disability?

No waiting period is required if you were previously entitled to disability benefits or to a period of disability under § 404.320 any time within 5 years of the month you again became disabled.

What makes a disability permanent?

If your treating doctor says you will never recover completely or will always be limited in the work you can do, you may have a permanent disability. This means that you may be eligible for permanent disability (PD) benefits. You don't have to lose your job to be eligible for PD benefits.