The definition of a pre-existing condition varies between insurance carriers and policies. Consumers shopping for health care coverage should read the fine print and note any distinctions or exclusions within a plan before choosing an insurance provider.

Definition

In general, a pre-existing condition is any disease, illness or injury that appeared, showed symptoms, and/or required medical consultation, advice or treatment before the effective date of a health insurance policy.

Significance

The presence of a pre-existing condition will result in refusal of coverage, denial of coverage for expenses related to that particular condition or higher health insurance premiums.

Time Frame

While each policy varies, there is typically a limitation on how long before the effective date of the insurance policy the pre-existing condition could occur. Most policies have a "look-back" from six months to five years before the policy began.

Considerations

While generally a pre-existing condition refers to illnesses such as asthma or cancer, or pre-coverage injuries, some insurance providers also consider pregnancy a pre-existing condition.

Warning

In an article posted on The Washington Monthly website on September 19, 2009, Steve Benen noted reasons for denial of coverage by health insurance providers included pre-existing conditions such as being an expectant father, toenail fungus, varicose veins, hazardous occupations (such as police officers), and even acne.

Source:

Good Neighbor Insurance: Pre-Existing Conditions

The Washington Monthly: The Broad Definition of "Pre-Existing Condition"