Preexisting Condition

Preexisting Condition

In insurance, a medical condition that existed before one applied for and/or received a health insurance policy. Most private health insurance companies refuse to cover preexisting conditions, at least for a certain period of time. Depending on the severity of the preexisting condition, a provider may refuse to provide health insurance at all. However, employer-provided health insurance must cover preexisting conditions if an employee switches insurance plans as the result of a job change.

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Preexisting condition. A preexisting condition is a health problem that you already have when you apply for insurance.

If you have a preexisting condition, an insurer can refuse to cover treatment connected to that problem for a period of time. That period is often the first six months, but may be for the entire term of your policy.

Insurers can also deny you coverage entirely because of a preexisting condition. And they can end a policy if they discover a preexisting condition that you did not report, provided you knew it existed when you applied for your policy.

However, if you're insured through your employer's plan and switch to a job that also provides health insurance, the new plan must cover you regardless of a preexisting condition.