What Is a Preexisting Condition?

A lot of people have health problems that insurance companies classify as a preexisting condition. When a person has a health problem before applying for a health insurance or joining a health plan, this is called a preexisting condition. For example, a person has high blood pressure; he had known about this condition, yet he still applied for health coverage.

Just like any other company, insurance companies and health plans are here to earn money. It’s beneficial for them if people who have preexisting condition are excluded. They do this by enforcing a waiting time before the coverage can start, or making them pay higher premiums, and asking them to pay expenses out of their own pockets.

If you have a preexisting condition, chances are it will be hard for you to get covered. Some insurance companies may accept your application, but they will impose a lot of conditions, and exclusion period. Some health plans will agree to have you covered; have you paid for the premium, but would not give you the entire cover that you paid for. The exclusion period can be from 6 to 18 months, depending on your insurance policy, and the state’s regulations.

Here’s an example: A lady, aged 40 years old, has been working as a secretary. She has a heart condition, and is currently taking medication. She purchased a health insurance that also covers her medication. However, there is 12-month exclusion for her heart condition. This means that any expenses relating to her heart condition is paid for solely by the lady. However, during this period she gets flu, expenses related to her flu sickness will be covered by the insurance company, because this is not considered a preexisting condition.

If you are applying for insurance through your employer, you may be given a preexisting exclusion period depending on the employer, and health plans being offered. The exclusion period is only for 12 months, and is only applicable to conditions that you had treated 6 months before you applied for a health plan.

Here’s an example: A man whose age is 33 who recently got employed after being jobless for a year. His new employer lets employees apply for a health plan by the end of the first payment period. This man has asthma and suffered from a knee injury ten years ago, while playing basketball. Six months before he applied for the health plan from his employment, he did not seek any medical help, and did not take any medication. Therefore, he was not subject to an exclusion period because of his preexisting conditions. After a couple of months, he had asthma attacks; the health plan was able to cover him for all asthma related care.

A preexisting condition can be classified as common or something that is serious. Some of these conditions include heart disease, high blood pressure, cancer, diabetes, and asthma. Not so serious conditions such as hay fever, and past injuries, however, do not qualify for such coverage.