What is considered pre-existing condition?

Asked by: Mrs. Amber Dach  |  Last update: January 27, 2024
Score: 4.4/5 (12 votes)

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 conditions are considered pre-existing conditions?

What are some examples of pre-existing health conditions? Chronic illnesses and medical conditions, including many forms of cancer, diabetes, lupus, epilepsy, and depression may be considered pre-existing conditions. Pregnancy before enrollment is also considered pre-existing and chronic.

How do you know if a condition is pre-existing?

In the health insurance world, a pre-existing condition is any injury, sickness or condition that exists before the date an insurance policy takes effect. Examples include asthma, diabetes, anxiety, depression, high blood pressure, high cholesterol and so on.

How far back is a pre-existing condition?

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 are pre-existing conditions exclusions?

Pre-existing Condition Exclusion. A limitation or exclusion of benefits for a condition based on the fact that you had the condition before your enrollment date in the group health plan.

What Is a Pre-existing Condition?

20 related questions found

Can you be denied insurance for pre-existing condition?

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.

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.

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.

What is a pre-existing condition if not diagnosed?

You don't need to have had a diagnosis for your symptoms to be considered pre-existing by your insurer. You may have gone for tests, scans or other investigations before you had health insurance and only received a diagnosis later.

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.

How long does pre-existing last?

The same goes for individual insurance purchased through a state or the federal health marketplace. Should a non-ACA-compliant plan still exclude pre-existing conditions, in most cases, it can only do so for a certain period—12 or 18 months, depending on when you enrolled.

Does Canadian healthcare cover pre-existing conditions?

Many Canadians have some kind of pre-existing condition, such as diabetes, asthma or other manageable conditions that don't have a debilitating impact on their daily lives. Insurance is certainly available for anyone with this kind of condition.

How do I get cover for pre-existing conditions?

Full medical underwriting

When you apply for cover, you'll need to fill in a questionnaire about your medical history. Your insurer might also need to speak to your doctor. Once they've gathered all the information, they'll decide what symptoms and conditions they can or can't cover and let you know.

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.

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 Thyroid a pre-existing condition?

All chronic medical diseases, such as high blood pressure, thyroid problems, and diabetes, are considered pre-existing conditions.

Is anxiety disorder a pre-existing condition?

However, insurance companies may have a specific list of conditions they consider as pre-existing, especially if you purchase outside the open enrollment periods. These typically include anxiety and mood disorders, personality disorders, psychotic disorders and other mental and behavioral conditions.

What is a 6 12 24 pre-existing condition definition?

Pre-Existing Condition Limitation 12/6/24 - A Pre-Existing Condition is a Sickness or Injury for which you have received treatment within 12 months prior to your effective date.

Does high blood pressure make you uninsurable?

If you have high blood pressure, you may be wondering if you can still get life insurance. The answer is yes, but your rates may be higher than someone with normal blood pressure.

What blood pressure is considered pre?

Prehypertension is defined as a systolic pressure from 120–139 millimeters of mercury (mm Hg) or a diastolic pressure from 80–89 mm Hg. Because blood pressure changes often, your health care provider will check it on several different days before deciding whether your blood pressure is too high.

What blood pressure is too high in pre?

You have gestational hypertension when: You have a systolic blood pressure of 140 mm Hg or higher and/or a diastolic blood pressure of 90 mm Hg or higher. The high blood pressure first happens after 20 weeks of pregnancy.

How do pre-existing conditions affect life insurance?

Due to the added risk health problems create for insurers, some pre-existing conditions can raise your premium or even disqualify you entirely from certain types of life insurance.

Is arthritis a pre-existing condition?

Rheumatoid Arthritis (RA) is a pre-existing medical condition defined as a chronic inflammatory disorder whereby one's own immune system actively attacks one's own tissues.

What is the longest period of time an insurer may exclude coverage for pre-existing conditions in an LTC policy?

Policies covering long term care services may not contain a preexisting condition limitation of more than six months after the effective date of coverage.

What is a pre-existing medical condition Canada?

Typically, a pre-existing condition is a medical illness or injury that was diagnosed or treated prior to leaving your Province or Territory of residence.