Pre-Existing Conditions (2024)

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.

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. Once you have insurance, they can't refuse to cover treatment for your pre-existing condition.

Exceptions

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Pre-Existing Conditions (2024)

FAQs

Pre-Existing Conditions? ›

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 counts as a pre-existing condition? ›

What are pre-existing medical conditions? 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.

Can you be denied for 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 pre-existing conditions disqualify you from 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. A few common examples of pre-existing conditions include high blood pressure, diabetes, cancer, and asthma.

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? ›

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- ...

How does insurance work with pre-existing 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.

What is the difference between existing and preexisting? ›

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.

Why can't pre-existing claims be denied? ›

Under federal law, a health insurance company cannot refuse to cover you or charge you more based on a pre-existing condition. A “pre-existing condition” is a health problem you had before the date your new coverage starts.

Does a pre-existing condition have to be diagnosed? ›

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.

What are 3 reasons you may be denied from having 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.

Is high blood pressure a pre-existing condition? ›

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.

Is obesity a pre-existing condition for insurance? ›

As obesity is a pre-existing condition the private health funds will not cover admissions for surgery until the person has been with them for 12-24 months. Call us for a quotation on (02) 4229 6355 – you might be surprised at just how affordable our uninsured program is.

Is arthritis a pre-existing condition? ›

A pre-existing condition is an injury or illness that was already present before the work injury. It may or may not have healed completely and is not necessarily related to your job. Examples of common pre-existing conditions that may affect your workers' comp claim include: Arthritis.

What is considered a pre-existing condition for UnitedHealthcare? ›

Pre-existing condition

A health condition that exists before the date that new health coverage starts.

What does it mean by pre-existing? ›

Definitions of pre-existing. adjective. existing previously or before something. synonyms: pre-existent, preexistent, preexisting antecedent. preceding in time or order.

What is a pre-existing condition if not diagnosed? ›

Does a pre-existing condition have to be diagnosed? This will depend on the terms set by the insurer. With some policies, a condition does not need a formal diagnosis to be considered a pre-existing medical condition – just that you've had symptoms and sought advice.

Is arthritis considered a pre-existing condition? ›

Some of the more common pre-existing conditions include asthma, arthritis, orthopedic problems, muscle strains or tears, and injuries suffered in past automobile accidents.

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