What is a "Pre-Existing Medical Condition"? (2024)

FAQs

What is a "Pre-Existing Medical Condition"? ›

Pre-existing conditions vary from worker to worker and patient to patient. They include conditions due to injury such as broken bones and arthritis due to surgeries. Pre-existing conditions also include diseases such as heart disease and cancer.

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.

Definition. HIPAA has defined pre-existing conditions to be health issues that have existed, treated of diagnosed within the last 6 months prior to employment.

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.

If in the last 12 months you have had, or been recommended to have, any: Medical investigation or tests for any conditions or symptoms that relate to a diagnosed condition. Treatment or surgery for any conditions or symptoms that relate to a diagnosed condition.

There are a number of other common health conditions that also would have qualified as a pre-existing condition. Pregnancy is classified as a pre-existing condition. Eating disorders are also pre-existing conditions, as is arthritis and even having had a knee replacement.

A few common examples of pre-existing conditions include high blood pressure, diabetes, cancer, and asthma. Previous injuries might be considered pre-existing conditions, depending on their severity and any lasting effects.

A medical illness or injury that you have before you start a new health care plan may be considered a pre-existing condition. Conditions like diabetes, chronic obstructive pulmonary disease (COPD), cancer, and sleep apnea, may be examples of pre-existing health conditions.

Pre-existing Disease means any condition, ailment, injury or disease: a) That is/are diagnosed by a physician within 48 months prior to the effective date of the policy issued by the insurer or its reinstatement. or.

Pre-existing conditions include all the long-term health issues ranging from high blood pressure and thyroid to diabetes, asthma, etc.

What is the medicare rule for preexisting conditions? ›

Yes. When you sign up for Original Medicare, any preexisting condition will be covered immediately. However, you'll still be responsible for all out-of-pocket expenses like deductibles, copayments and coinsurance.

Examples of pre-existing medical conditions include, diabetes, asthma, high cholesterol or a long-term back condition.

The Affordable Care Act (ACA or “Obamacare”) prohibited pre-existing condition exclusions for all plans beginning January 2014, which was great news for all insurance beneficiaries with pre-existing conditions.

An illness or injury experienced before enrollment in a health insurance plan may be considered a pre-existing condition. Pre-existing conditions can include health issues such as cancer, diabetes, lupus, depression, acne, pregnancy, or just about any other health condition you can imagine.

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.

While younger and healthier people qualify for more affordable life insurance options, having one or more pre-existing conditions does not automatically disqualify you from eligibility. Typically, those with pre-existing conditions face fewer choices and higher rates, but there are policy options available.

Preexisting conditions are issues that are already there, that usually affect the existing conditions. Pre means “before”. Often, if a person has a preexisting heart condition, they could be denied insurance. That is only one example.

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.

Stability refers to the requirement of a policy, that there be no changes in a medical condition for a period of time.

Is back pain a pre-existing medical condition? Yes.