What Is a Pre-Existing Condition in Regards to Health Insurance?
If you're starting a new job with health insurance benefits, or considering buying health insurance for yourself, be prepared to divulge information about pre-existing conditions -- one of the insurance industry's favorite phrases.-
Definition
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In insurance terms, a pre-existing condition is a condition or diagnosis that existed or was being treated before insurance coverage was secured under a current plan.
Significance
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A pre-existing condition may make it difficult or impossible to purchase private health insurance. Premiums for individuals with conditions that are perceived to result in high health care costs may make purchasing insurance prohibitively expensive. Or, insurance companies may offer coverage that is not extended to the pre-existing condition. Group health insurance plans legally can elect not to cover pre-existing conditions for most people from 12 to 18 months, depending on circumstances, under HIPAA regulations.
Considerations
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A pre-existing condition often includes conditions you've suffered in the past but are no longer seeking treatment for, such as cancer, carpal tunnel syndrome or high blood pressure. Although HIPAA restricts group plans from looking at records prior to six months before coverage begins, private insurance purchasers have no such protection.
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