1. Home
  2. Health
  3. Health Insurance

Pre-existing Condition

From Kelly Montgomery, for About.com

Updated: June 05, 2008

About.com Health's Disease and Condition content is reviewed by our Medical Review Board

Definition: Any health condition you already have when you enroll in a health insurance plan or policy.

If you get your insurance coverage through your job, federal law governing pre-existing conditions applies. Your insurer will be permitted to "look-back" to see if you received any medical attention or diagnosis during the six-month period immediately preceding your enrollment. The insurer will use this information to determine what medical conditions you already had when you enrolled. So if you received medical care for a particular condition more than six months prior to enrollment, then that condition is not pre-existing under federal law.

If you have an individual health insurance policy, federal law will not apply, so insurers may be permitted to "look-back" at your claims history for the past year, eighteen months or even longer when determining if you have any pre-existing health conditions. Rules governing pre-existing conditions and "look-back" periods for individual policies vary by state.

Source:

United States Department of Labor, Employee Benefits Security Administration. "Frequently Asked Questions About Portability of Health Coverage and HIPAA." Accessed June 3, 2008.

Explore Health Insurance
About.com Special Features

Learn how you can reduce your your numbers with these nutrition and exercise tips. More >

Keep yourself, and your family, happy and healthy this fall with these tips. More >

We comply with the HONcode standard for trustworthy health information: verify here.
  1. Home
  2. Health
  3. Health Insurance
  4. Glossary
  5. Pre-existing Condition - Definition of Pre-existing Condition

©2009 About.com, a part of The New York Times Company.

All rights reserved.