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What is a Pre-Existing Condition?

Generally speaking, most health insurance plans now provide coverage for preexisting conditions. That was one of the major features of Obamacare. There are still some plans though, that continue to have preexisting condition exclusions in their policies. One year Short Term Plans are an example of a health insurance policy that still does. This allows the insurance company to underwrite the policy, thereby offering much lower rates to a relatively healthy block of business. So what exactly is a preexisting condition?

Simply stated, it’s a condition, diagnosis, illness or injury that was present before the effective date of the policy. But there are some limits on what can be deemed preexisting.

Time Limit
The insurance company cannot go back forever. Depending on the policy and state limitations, the look back for treatment or diagnosis is from 6 months to 24 months. This means that if the look back is one year, than something you were treated for over one year ago would not be a preexisting condition, provided that you had also been symptom free since that time as well.

Symptoms
What if you were never specifically diagnosed by a doctor? If you had symptoms for a condition over the past year, that would have caused a person to reasonably seek treatment, then you could also be considered as having a preexisting condition, even if you never saw a doctor for those symptoms.

The elimination of exclusions for preexisting conditions has been a great benefit to many people, but if you are healthy and have no previous diagnosis or symptoms that fall into the categories above, then you could also benefit from a lower cost policy that underwrites the application.

Call us a 615-376-8899 for information on small group or individual health insurance.


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