What is considered a pre-existing medical condition?
Asked by: Reinhold Sipes Jr. | Last update: November 20, 2025Score: 4.9/5 (15 votes)
What is an example of a pre-existing condition?
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 counts as a pre-existing health condition?
It applies to any medical condition that you saw your doctor about the five years before the start date on your health insurance. For example, you might take out a policy and then go and see your GP about some back pain you've been experiencing.
How long is something considered a pre-existing condition?
Any condition (either physical or mental) including a disability for which medical advice, diagnosis, care, or treatment was recommended or received within the 6-month period ending on your enrollment date in a health insurance plan.
How long ago is a pre-existing condition?
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'.
Pre-existing medical conditions - Health Insurance
What is the waiting period for pre-existing disease?
Almost all health insurance plans cover pre-existing diseases after a waiting period of usually 2 to 3 years. This implies that any hospitalization expenses related to the declared ailments can be claimed only after 2 to 3 successful years with the insurer.
Is high blood pressure considered a pre-existing condition?
Insurers generally define what constitutes a pre-existing condition. Some are obvious, like currently having heart disease or cancer. Others are less so – such has having asthma or high blood pressure.
How do insurance companies know if you have a pre-existing condition?
To determine if a condition is pre-existing, insurers examine medical history, treatment records, and diagnosis reports. They may use “look-back periods,” which are specific timeframes—typically six months to a year before coverage begins—to review medical history.
What does 12 months for pre-existing mean?
What does this mean for me? If your condition has been deemed as pre-existing by our medical practitioner, you'll need to serve the 12-month waiting period (or the remaining part of the period if you have served some of it with your previous fund) before you can claim for the service or treatment.
Is high cholesterol a pre-existing condition?
Does high cholesterol count as a pre-existing medical condition? Yes. High cholesterol is considered a pre-existing medical condition by insurance companies, along with similar conditions like high blood pressure.
What qualifies as a medical condition?
A 'medical condition' refers to a specific health issue or illness that can be diagnosed by healthcare providers based on symptoms, medication use, or diagnostic testing. It includes a wide range of conditions that impact an individual's health and ability to function, such as chronic diseases or acute illnesses.
Is acid reflux considered a pre-existing condition?
Is reflux really a pre-existing medical condition? The simple answer is yes.
Does depression count as a pre-existing medical condition?
Many insurance policies do not cover pre-existing conditions. This means that they will not pay out on a claim related to a pre-existing condition, including mental health problems. For example, if you have a diagnosis of depression when you apply for insurance, this would be considered a pre-existing condition.
What is an example of a pre condition?
It's the thing that has to happen before something else happens. For example, as a precondition to getting your allowance, you might have to give the dog a hairdo once a week. Precondition is often used in the negative – when world leaders meet to discuss something, they might ask for no preconditions.
What are my pre-existing conditions?
A pre-existing condition is any condition you had before your policy started. A chronic condition is something that is on-going and that has no known cure. Asthma, arthritis and diabetes are examples of chronic conditions.
Are blood clots a preexisting condition?
Certain people are genetically disposed to blood clots, putting them at higher risk of a pulmonary embolism, so a family history can help your doctor identify the issue. Additionally, preexisting conditions like heart disease, interstitial lung disease, COVID-19, or many forms of cancers can make clotting more likely.
How far back does pre-existing condition last?
A group health plan can count as pre-existing conditions only those conditions for which you actually received (or were recommended to receive) a diagnosis, treatment or medical advice within the 6 months immediately before you joined that plan. This period is known as the “look back” period.
What makes a condition pre-existing?
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 long is a pre-existing medical condition?
The insurer will only tell you if you're covered at the time you make a claim. They won't cover you for any conditions you've had in the five years before you took out the insurance. But if you've not had treatment, medication or advice for those conditions for two years, they may cover you for them in the future.
What is the waiting period for pre-existing diseases?
Pre-existing diseases (PED) are mostly expensive to treat as they are chronic in nature. Unfortunately, most health insurance plans cover pre-existing diseases after a waiting period of 1 to 3 years as people are already suffering from such diseases at the time of policy purchase.
Is arthritis a pre-existing condition?
Examples of pre-existing conditions include: Chronic diseases (hypertension, heart disease, chronic obstructive pulmonary disease (COPD)) Mental health disorders (depression, anxiety, PTSD) Autoimmune diseases (rheumatoid arthritis, multiple sclerosis (MS), Crohn's disease)
Is stroke considered a pre-existing condition?
Any medical illness, injury, or condition that you have been treated for previously is considered a pre-existing condition. That can be as simple as a sprained ankle, the flu, or asthma. It can also include much more complex conditions and treatments like cancer, stroke, or heart attacks.
What will disqualify me from life insurance?
A few common examples of pre-existing conditions include high blood pressure, diabetes, cancer, and asthma. Previous injuries might be considered pre-existing conditions, depending on their severity and any lasting effects.
How do you know if a condition is pre-existing?
A pre-existing condition is defined as any ailment, illness, or condition where, in the opinion of a medical adviser appointed by the health insurer, the signs or symptoms of that illness, ailment or condition existed at any time in the period of 6 months ending on the day on which the person became insured under the ...
What is the medicare rule for preexisting conditions?
Does Original Medicare cover preexisting conditions? Yes. When you sign up for Original Medicare, any preexisting condition will be covered immediately. You'll still be responsible for all out-of-pocket expenses like deductibles, copayments and coinsurance.