What is a pre-existing conditions clause and what is the effect of its inclusion in a major medical plan?
A pre-existing condition is often defined as a medical condition (i.e., an injury or illness) that required treatment during a prescribed period of time, e.g., 6 months, prior to the insured’s effective date of coverage under a major medical expense plan. A pre-existing conditions clause denies coverage to individuals on account of specific pre-existing conditions; such conditions may be excluded for periods of as long as 12 months to 2 years after the effective date of coverage. From time to time, the definition and provisions of the clause may differ considerably from one plan to another; we therefore suggest that all newly and prospective insureds thoroughly familiarize themselves with the provisions of a policy before and after they apply for coverage.
