WHAT IS A PRE-EXISTING CONDITION?
A pre-existing condition is defined as a prior illness or injury for which the policyholder has produced signs of or has had symptoms within the first 12 months of coverage or has received medical advice, diagnosis, treatment or services from a physician within the 12 month period prior to the person’s effective date.
Different health insurance companies define pre-existing conditions slightly differently, but in general, a pre-existing condition is one for which you received medical advice or treatment in the two to five years prior to your applied for effective date for coverage of this condition or a condition with symptoms that would cause a prudent person to seek treatment in the one to five years prior to your applied for effective date for coverage of this condition. Some companies will not exclude coverage for pre-existing conditions provided that the condition is fully disclosed on the application and is not excluded in underwriting. Pre-existing conditions may be excluded from coverage by an insurance company for six to twelve months.
Pre-Existing Condition means: (a) the existence of symptoms which would cause an ordinarily prudent person to seek diagnosis, care or treatment within a one year period preceding the effective date of the covered person’s insurance; or (b) a condition for which medical advice or treatment was recommended by a doctor or received from a doctor within a one year period preceding the effective date of the covered person’s insurance.
A pre-existing condition is usually defined as any medical condition, whether illness or an injury, that required treatment prior to the person taking out health insurance. The specific terms vary among insurance providers — some include conditions known about only three months before the effective date of coverage, while others exclude coverage of any pre-existing condition for as long as a year after the effective date of coverage. While some providers include only conditions that required treatment, others include any condition the insured knew about, even if it did not require treatment.
