Pre-existing Medical Condition Exclusions (2024)

FAQs

Can pre-existing conditions be excluded? ›

Health insurers can no longer charge more or deny coverage to you or your child because of a pre-existing health condition like asthma, diabetes, or cancer, as well as pregnancy. They cannot limit benefits for that condition either.

Preexisting Condition Exclusion – Basic Rule

A plan cannot impose a limitation with respect to a given condition unless it is one for which medical advice, diagnosis, care, or treatment was recommended or received within a period of not more than six months before the individual's enrollment date.

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.

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.

Exclude pre-existing medical conditions – you would receive medical travel insurance, but the insurer won't pay out for claims directly or indirectly related to your existing illness.

Failure to disclose pre-existing conditions not only jeopardizes the chances of successful claims but may also lead to the cancellation of the policy in extreme cases.

It applies to any medical condition that you saw your doctor about the five years before the start date on your health insurance. For example, you might take out a policy and then go and see your GP about some back pain you've been experiencing.

A pre-existing medical condition (PEMC) is an illness or injury you had before your policy began or was renewed. Examples of pre-existing medical conditions include, diabetes, asthma, high cholesterol or a long-term back condition.

Simply put, the Waiver of Pre-Existing Medical Conditions covers, or “waives” the companies right to exclude pre-existing medical conditions from their policy. It's a feature only available with certain comprehensive package plans that include trip cancellation/trip interruption.

In the world of personal injury law, there's a principle known as the “eggshell plaintiff” rule. This rule essentially states anyone injuring another person is responsible for all the consequences, even if the person had a pre-existing condition that worsened the injuries.

What qualifies as a pre-existing condition? ›

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.

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.

A pre-existing condition exclusion period limits the number of benefits that an insurer has to provide for specific medical conditions and does not apply to medical benefits afforded by a health insurance policy for other types of care.

Pre-Existing Diseases (PED) Waiting Period

Generally, the waiting period for pre-existing disease in health insurance plans is 1-4 years. However, the pre-existing disease waiting period varies with the health condition of the insured as well as the health insurance plan they choose.

Affordable Care Act

So group health plans no longer have pre-existing condition exclusion periods, regardless of whether the enrollee has a history of continuous coverage and/or pre-existing conditions.

A long-term care insurance policy or certificate, other than a policy or certificate that is issued to a group, may not exclude coverage for a loss or confinement that is the result of a preexisting condition unless the loss or confinement begins within six months following the effective date of coverage of an insured ...

In some cases, a Medigap insurance company can refuse to cover out‑of‑pocket costs for preexisting health problems for up to 6 months. This is called a “preexisting condition waiting period.” After 6 months, the Medigap policy will cover the preexisting condition.

Medical History Disregarded (MHD) in most cases allows previous medical conditions to be considered for claim. Regardless or not at what point in time that these conditions existed.