A “pre-existing condition” is a health condition that exists before someone applies for or enrolls in a new health insurance policy. Insurers generally define what constitutes a pre-existing condition. Usually, preexisting conditions are any medical conditions for which treatment was received or should have been received. 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. Plans are permitted to exclude coverage for employees (over the age of 19) with pre-existing conditions, however this will be eliminated in 2014 due to health care reform.
A plan with pre-existing exclusionary periods, coverage can be denied to a person with a pre-existing condition. However, if an employee is able to provide a “Notice of Creditable Coverage” it would reduce or eliminate the exclusionary period of coverage. Without the notice, an employer is able to impose an exclusionary period of up to 18 months.