What is considered a preexisting condition?


A pre-existing condition refers to a sickness or injury a person has been suffering even before a person bought health insurance coverage.

Under the principles of insurance, it will only protect against future events. And since pre-existing conditions are essentially past events, the insurance company won't cover it. You can think of it like this - it's like someone buying fire insurance when his house is in the process of burning.

Pre-existing conditions are usually conditions that are chronic and can be expensive to treat for an extended period of time. These include heart disease, asthma, diabetes, or mental illness. Or else, it may be as simple as the fact that one is overweight.

Depending on the definition of an insurance company, a pre-existing condition is one where:

  • The insured has received treatment in the last six months prior to buying the policy
  • The insured has been checked and is awaiting diagnosis
  • The insured did not get treatment but has already been exhibiting symptoms of the disease

In the past, health insurance providers have denied coverage to those who have a pre-existing illness. Or else, they have excluded these illnesses from their coverage or charged very high premiums. Also, to prevent people from getting health insurance coverage for their pre-existing conditions, insurance plans usually have a waiting period where specified illnesses are not considered payable if they happen within that waiting period.

However, with the health reform bill, you don't have to worry about not getting insurance coverage due to your pre-existing condition. The implementation will start with the children. Starting September 2010, children won't be denied coverage nor will their pre-existing be excluded from the insurance.  These same conditions will also be true for adults, but this will not take effect on January 2014.

In the meantime, there will be state-run health insurance exchanges that will enable people to buy insurance even if they have pre-existing conditions.

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