What is the limitation period for pre-existing conditions?
Asked by: Laura Dicki | Last update: October 20, 2025Score: 4.7/5 (22 votes)
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 is the maximum time period that pre-existing conditions can be?
The plan was allowed to look back at the previous six months of the person's medical history, and exclude pre-existing conditions that were treated during that six months, with the exclusion period lasting no more than 12 months.
What is the exclusion period for pre-existing conditions?
If you are joining a fully insured group health plan in California, the maximum exclusion period is 6 months. If you are joining a self-insured group health plan, the maximum exclusion period is 12 months. You will receive credit toward your pre-existing condition exclusion period for any previous continuous coverage.
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.
Can I get around a pre-existing condition limitation in a disability policy?
What is the waiting period for a pre-existing condition under a Medicare?
In some cases, the Medigap insurance company can refuse to cover your out of pocket costs for these pre‑existing health problems for up to 6 months. This is called a “pre‑existing condition waiting period.” After 6 months, the Medigap policy will cover the pre‑existing condition.
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.
How far back 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'.
What does a pre-existing condition limitation not apply?
Insurers in some states could have restrictions added on whether they can include a pre-existing condition exclusion period. Today, insurers cannot deny coverage to somebody based on pre-existing conditions, nor charge more.
How long can an insurer exclude coverage for preexisting condition on a Medicare supplement policy?
Be aware that under federal law, Medigap policy insurers can refuse to cover your prior medical conditions for the first six months. A prior or pre-existing condition is a condition or illness you were diagnosed with or were treated for before new health care coverage began.
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 is the pre-existing condition review period?
Most travel insurance providers impose a lookback period to verify if a claim is relating to a pre-existing medical condition. A lookback period is a time-frame, which typically ranges from 60-180 days, in which a provider can review your medical records and history.
What is a stable pre-existing condition?
Stability refers to the requirement of a policy, that there be no changes in a medical condition for a period of time.
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.
What is the exclusion period?
The time period during which an individual policy won't pay for care relating to a pre-existing condition. Under an individual policy, conditions may be excluded permanently (known as an "exclusionary rider"). Rules on pre-existing condition exclusion periods in individual policies vary widely by state.
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.
Can Medicare deny coverage for preexisting conditions?
While Original Medicare doesn't restrict coverage based on pre-existing conditions, the rules are different for Medicare Supplement insurance plans. In some cases, insurance companies can review your medical history and charge you more, impose a waiting period for coverage, or deny your application altogether.
What is the 6 12 pre-existing condition limitation?
If it's a 6/12, then the insurance company will look back 6 months for a pre-existing condition for any claim filed in the first 12 months. If the condition was pre-existing during the look back period, then the insurance company can deny the claim.
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 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.
Can you get life insurance if you have a pre-existing condition?
Can people with pre-existing conditions qualify for life insurance? People with pre-existing conditions can still qualify for various life insurance policies. However, they may pay more in premiums because personal health history is a key factor that insurers use to calculate rates.
Why doesn't insurance cover pre-existing conditions?
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 exclusion for pre-existing conditions?
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 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.
What is the 12 month waiting period for pre-existing conditions?
12-months Condition Specific Waiting Period – this is a period during which a member is not entitled to claim benefits in respect of a condition for which medical ad- vice, diagnosis, care or treatment was recommended or received within the 12 month period ending on the date on which an application for membership was ...