Pre-existing medical conditions (2024)

FAQs

Pre-existing medical conditions? ›

A pre-existing condition is any illness or condition a patient has prior to obtaining insurance. In the past, people could be barred from getting a health plan because of a pre-existing condition. Thanks to the Affordable Care Act, pre-existing conditions are no longer grounds for refusing to sell someone insurance.

A health problem, like asthma, diabetes, or cancer, you had before the date that new health coverage starts.

A pre-existing medical condition (PEMC) is an illness or injury you had before your policy began or was renewed. Examples of pre-existing medical conditions include, diabetes, asthma, high cholesterol or a long-term back condition.

Pre-existing conditions can make it more difficult and expensive to get life insurance, but even if you have a chronic or terminal health problem, you can likely find a policy you qualify for if you shop around.

A serious pre-existing condition is one that may require intensive medical intervention to treat or manage; or have high risk of future complications or recurrence, and therefore may require prolonged treatment.

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. They cannot limit benefits for that condition either.

Post-claims underwriting can also be used by these non-ACA-compliant plans, meaning that they'll accept most applicants with little in the way of upfront underwriting, but will then do a thorough check of the person's medical history if and when they have a medical claim; if the condition is determined to be pre- ...

Existing is a certain thing that is present nowadays and can be seen in present time. Preexisting refers to something that has existed a long time ago, and forgotten, and has existed once more in our present time.

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.

A pre-existing condition can refer to the following: A past injury or illness that you have already recovered from (such as a broken ankle from your youth)

What disqualifies me for life insurance? ›

They can include engaging in risky hobbies and behaviors like skydiving; having a history of DUIs or speeding tickets; having a dangerous job like roofing; having a criminal record or a less than ideal financial history; being a smoker; and failing a drug test.

Pre-existing diseases or PED is a kind of chronic or long-term medical condition which already exists at the time when one buys a health insurance. The most common examples of pre-existing diseases are: High blood pressure.

Serious criminal convictions

Some insurance providers may decline coverage if the applicant has a history of serious crimes such as murder, sexual assault, or drug trafficking.

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.

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.

A 12/12 pre-existing condition means that if you have a claim in the first twelve months, the insurance company will look back 12 months before you started the policy to see if you had a pre-existing condition that might have caused it. You'll find the most common pre-exes are 3/12, 6/6, 6/12 and 12/12.

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. A pre-existing condition might be mild – for example, seasonal allergies or acne treated with simple medications.

Before 2014, some insurance policies would not cover expenses due to pre-existing conditions. These exclusions by the insurance industry were meant to cope with adverse selection by potential customers. Such exclusions have been prohibited since January 1, 2014, by the Patient Protection and Affordable Care Act.