What is considered a pre-existing condition?

If you are among the many Americans shopping for new health insurance plans, you may come across a variety of terms both familiar and unfamiliar. One such term is "pre-existing condition." While pre-existing conditions may sound quite intimidating, particularly since you may have heard they can lead to more expensive premiums or even the denial of coverage, what exactly do pre-existing conditions entail?

A pre-existing condition, quite simply, is any health problem that you may have had prior to the first day of coverage under a new health insurance plan. However, this does not necessarily mean that your condition will not be covered. Many factors will be taken into consideration, including the amount of care you’ll require, whether or not you were insured before this plan, and what type of plan you now carry. A family history of a condition or a genetic predisposition towards a condition is not considered a pre-existing condition.

Rules may also vary depending on whether you have a group health plan or a personal health insurance plan. Group health insurance plans tend to be more inclusive, while individual health plans may be more restrictive.

Some conditions may not affect your coverage at all, while others may limit the terms of your coverage for up to a year after your plan takes effect. Your coverage may cover standard health care but limit or exclude coverage for treatment of that particular condition. Common pre-existing conditions include type 2 diabetes, depression, obesity, arthritis, pregnancy, and fibromyalgia.

Whether you have a pre-existing condition and are searching for a new HMO health insurance plan or a PPO health insurance plan, there are many affordable options available today from which you can choose. A qualified insurance professional can help you understand whether or not and how your pre-existing condition may affect your coverage now and over the long term.

Source: Los Angeles Health Coverage
Back to Blog