What is considered a preexisting condition?
Asked by: Colten Ebert Sr. | Last update: November 10, 2025Score: 4.7/5 (45 votes)
What counts as a pre-existing medical condition?
You may have gone for tests, scans or other investigations before you had health insurance and only received a diagnosis later. It applies to any medical condition that you saw your doctor about the five years before the start date on your health insurance.
What pre-existing conditions are not covered?
Is there health insurance for pre-existing conditions? Choosing a health plan is no longer based on the concept of a pre-existing condition. A health insurer cannot deny you coverage or raise rates for plans if you have a medical condition at the time of enrollment.
What is an example of 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 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.
What is a preexisting condition? | WPS Explains
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'.
How do insurance companies determine pre-existing conditions?
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 is the legal definition of 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.
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 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.
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 surgeries are not covered by insurance?
Cosmetic procedures such as plastic surgery or vein removal are nearly always considered elective and so are not covered. Fertility treatments are only covered in certain states, and even then, there are loopholes that allow insurers to deny coverage.
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.
Is high cholesterol considered 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 a broken leg a pre-existing condition?
Pre-existing conditions can include serious illnesses, such as cancer. It can also include less serious conditions, such as a broken leg, and in some cases, even prescription drugs can count as a pre-existing condition.
What are the most common pre-existing conditions?
Pre-existing conditions were based on a modified version of the Kaiser Family Foundation (KFF) list of common “declinable medical conditions” maintained by more than half of insurers,3 which included HIV/AIDS; lupus; alcohol and drug abuse (excludes tobacco use); mental disorders (eg, depression, bipolar disorder); ...
What is included in pre-existing condition?
What Is a Preexisting Condition? A preexisting condition is a known illness, injury, or health condition that existed before someone enrolls in or begins receiving health or life insurance. This includes illnesses such as heart disease, diabetes, cancer, and asthma.
What is an example of preexisting?
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.
How long is a condition considered pre-existing?
The length of time before the start date of coverage during which a condition would be considered pre-existing varies, and can be anywhere from 30 days to 6 months or longer.
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.
Is GERD a pre-existing condition?
It may, as GERD is considered a pre-existing condition and could potentially lead to higher premiums or difficulty finding coverage. However, each insurance company has their own underwriting guidelines and some may not consider GERD to be a significant risk factor.
Can insurance decline preexisting conditions?
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.
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.
How do home insurance companies determine pre-existing damage?
Generally, insurance companies do not pay out on policies if they determine that the covered property has pre-existing damage. The determination of the pre-existing damage is done through valuations and investigation by the insurance company.