What Is a Preexisting Condition for Health Insurance?

With continually escalating health care costs, the average person can find it difficult to pay for health care without insurance. One problem with some health insurance policies is that they won't cover expenses related to a preexisting condition.

Definition

• A preexisting condition is defined as any medical condition that was or should have been treated before the policy went into effect. The preexisting-condition time limit varies. It can be as long as two years prior to the date of coverage, depending on the policy.

Coverage Denial

• Insurance companies can charge a higher premium or refuse to sell coverage because of a preexisting condition. They can also deny coverage for treating the specific preexisting condition but cover other health-related expenses.

In Ohio

• An insurance policy's exclusion period for a preexisting condition can depend on the state. For example, in Ohio the period cannot be longer than 12 months following the effective date of coverage and may only exclude coverage for medical conditions that emerged during the six-month period prior to the date the coverage started.

HIC's and HMO's

• HMOs and HICs (health insuring corporations) cannot impose a waiting period for a preexisting condition. Medical conditions that existed before the policy goes into effect are covered immediately. The same usually applies to health plans offered by an employer.

HIPAA

• Under the federal Health Insurance Portability and Accountability Act (HIPAA), people insured through their employer for at least 18 months are covered right away on a new employer's insurance plan, without preexisting-condition or waiting-period exclusions. Some states have modified and expanded on these provisions, so there will be slight variations from state to state.

Medigap

• For health care related to a preexisting condition, a Medicare supplement policy (Medigap) will not exclude or limit coverage for more than six months from the effective date of coverage.