What Qualifies as a Pre-Existing Health Condition?

When you obtain health insurance coverage, you may not be covered for pre-existing conditions, at least at first. Many health insurance companies have a six- to eighteen-month exclusion period for coverage of pre-existing conditions. This means that although you are paying your monthly health insurance premiums, issues for which you have sought medical attention in the past are not covered during that time frame. Some health insurance companies will not cover an individual with a history of pre-existing conditions, while others will raise the premiums.

A Complex Definition

Pre-existing conditions are defined differently by health insurance providers and employers. Some insurance companies define a pre-existing condition as something for which you have sought medical attention in the past six months. Some states have regulations that determine how long ago the medical issue must have occurred to be defined as a pre-existing condition. Others allow insurance companies to look at a patient’s entire medical history.  Some insurance companies and products define a pre-existing condition as a medical condition that existed before seeking coverage, regardless of whether or not the individual sought medical attention for it.

Examples of Pre-Existing Conditions

• Pregnancy: If a woman applies for health insurance after the date her child was conceived, the insurance company may not cover the cost of delivering her baby.
• Mental illness: If you have received medical treatment for depression, anxiety, bipolar disorder, or other mental illnesses, you may be denied coverage.
• Chronic conditions: Medical conditions such as fibromyalgia, arthritis, high blood pressure, asthma, and diabetes are considered chronic conditions. Whether or not they count as pre-existing health conditions depends on the insurer. Some insurance companies only look at whether an individual has been to a doctor within the past six months. If you have asthma but have not used medication or seen a doctor for the condition in the past six months, your asthma may be covered.
• Cancer: Whether you have a history of cancer or are currently undergoing treatment, you may be denied coverage or have to pay higher premiums.
• Heart disease: Patients with serious heart disease or those who have undergone heart surgery may be considered as having a pre-existing condition.

Your Medical Records

Even if you don’t disclose a particular medical condition when you apply for health insurance coverage, the insurance company may find out about previous illnesses from the Medical Information Bureau. Similar to credit reporting agencies, the Medical Information Bureau provides information about patients’ medical history to insurance companies. Medical information is kept on file for seven years, and individuals can access their Medical Information Bureau report once a year for free. This can help them determine whether now is a good time to apply for health insurance (or health-related insurance, such as life insurance).

Affordable Care Act

The Affordable Care Act, which was passed in 2010, protects individuals with pre-existing conditions. The Act provides Pre-Existing Condition Insurance Plans (PCIPs) to patients who have been denied health insurance for a pre-existing condition. By the year 2014, discrimination against patients with pre-existing conditions will be forbidden.

When you apply for health insurance, don’t lie about your medical history. If you do have a pre-existing condition, it is likely that the insurance company will uncover it anyway. Instead, make sure you are aware of what qualifies as a pre-existing condition and what the guidelines are for the specific insurance you are applying for. Since different companies have different specifications, you may be covered if you wait a few months before applying or if you get your condition under control before seeking a new health insurance policy.

Author bio: Finding the right plan for your loved ones is difficult. Author Liam Murphy suggests the site Key Insurance Quotes for more information to make this planning easier for families.