Preexisting condition

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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.
Farlex Financial Dictionary. © 2012 Farlex, Inc. All Rights Reserved

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.

Dictionary of Financial Terms. Copyright © 2008 Lightbulb Press, Inc. All Rights Reserved.
References in periodicals archive ?
The pre-existing condition provision barred payment of benefits for disability due to any sickness for which the employee received medical care during the 90-day look-back period before the effective date of coverage.
The ACA prevents health insurance companies from: 1) denying someone health insurance because they have a pre-existing condition called the "guaranteed issue" requirement; 2) refusing to cover services that people need to treat a pre-existing condition called "pre-existing condition exclusions"; and 3) charging a higher premium based on a person's health status called the "community rating" provision.
"These plans are not required to cover pre-existing conditions. The only coverage that guarantees that protection is the Affordable Care Act.
Nationally, 40 percent of Americans age 50 to 64 have a pre-existing condition. Arkansas would be hit especially hard as 52 percent of Arkansans ages 50 to 64 have a pre-existing condition.
An International Business Times review of federal records shows that America's Health Insurance Plans (AHIP) listed the pre-existing condition issue on disclosure forms documenting nearly $81 million worth of lobbying since the passage of the ACA.
Before enactment of the Affordable Care Act (ACA), also known as ObamaCare, insurance companies could deny healthcare coverage to people who had pre-existing conditions. These denials potentially affected a total of 50 million people, including 17 million children.
However, if you think about it, liking the part of Obamacare that eliminates pre-existing conditions, but being opposed to the mandate does not make any sense.
The goal is to provide an insurance option to people who may be barred from coverage or who have to pay huge surcharges because of a pre-existing condition such as hypercholesterolemia or cancer.
You may know someone, a citizen of the US or a legal resident of the US, who has been without insurance for more than 6 months, and who is without insurance because of a pre-existing condition. This insurance coverage is for anyone that meets the criteria above and who has a letter of denial form from his/her insurance company.
"With a counter-offer, someone with a pre-existing condition who wants a $20 copay and a $500-deductible PPO plan might receive a counter-offer with a $20 copay, but a $5,000 or $10,000 deductible and a 70 percent coinsurance," Karutz said.
So, of course, the one that gained the most notoriety had to do with insurers parsing the bill's fine print and coming up with a justification for not insuring some kids with pre-existing conditions until 2014.