Understanding Pre-Existing Condition Exclusions in Health Insurance

Pre-existing condition

How do insurers know about pre-existing conditions?

While insurers generally determine the presence of a pre-existing condition based on an applicant’s current health status, sometimes a healthy applicant can be deemed to have a pre-existing condition based on a past health problem or evidence of treatment for a particular condition.

Understanding Pre-Existing Condition Exclusions In Health Insurance

When purchasing health insurance, it is important to understand whether or not pre-existing condition exclusions are included in the coverage. Pre-existing condition exclusions are restrictions on the coverage provided for any medical condition you have already been diagnosed with at the time of signing up for the plan. In other words, if you have a pre-existing condition, the insurance company may not cover any medical costs associated with that condition.

Pre-existing condition exclusions are common in many health insurance policies. Typically, insurers will look back at the medical history of the applicant for the prior year and make the determination whether a condition is pre-existing or not. Some of the most common pre-existing conditions excluded from health insurance policies are cancer, heart disease, and diabetes.

Under the Affordable Care Act, individual and small group health insurance must cover all pre-existing conditions, but it is important to note that this does not apply to larger employer-sponsored plans.

Though pre-existing condition exclusions are bothersome, there are a few ways to get around them. For example, if you have a pre-existing condition and an individual health plan, one option is to join an employer-sponsored plan. Additionally, some insurers will offer riders that will provide coverage for certain pre-existing conditions if you are willing to pay an additional premium.

It is important to understand pre-existing condition exclusions if you are looking for health insurance coverage. Doing research upfront will help you make the best decision about the insurance plan that is right for you.

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