What is a pre-existing condition and whats the difference between the “objective standard” and the “prudent standard” of the definition of a pre-existing condition?
A pre-existing condition is a medical condition or healthcare problem that existed before enrolling in a healthcare plan. The “objective standard” of the definition states that a pre-existing condition is anything for which you’ve received medical advice, care, diagnosis and treatment prior to your enrollment. By contrast, the “prudent standard” of the definition states that a pre-existing condition is any condition for which symptoms were present although medical advice, care, diagnosis, or treatment may not have been received prior to enrollment. Under the “prudent standard,” an “ordinarily prudent” individual surely would have sought medical advice, care, diagnosis, or treatment for any symptoms that were present prior to enrollment. Most states implement the prudent standard of the definition.
