1. Health

Pre-Existing Condition Exclusion Period

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Updated January 05, 2010

Definition:

A pre-existing condition can affect your health insurance coverage. If you are applying for insurance, some health insurance companies may accept you conditionally by providing a pre-existing condition exclusion period.

Although the health plan has accepted you and you are paying your monthly premiums, you may not have coverage for any care or services related to your pre-existing condition. Depending on the policy and your state’s insurance regulations, this exclusion period can range from six to 18 months.

If you are getting insurance at your job, depending on your employer and the health plans offered, you may have a pre-existing exclusion period. However, the exclusion period is limited to 12 months (18 months if you enrolled late in the health plan) and only applies to health conditions for which you sought treatment in the 6 months before you enrolled in the health plan.

More Information from Dr. Mike:

Examples:

Mike J. recently got a new job after being unemployed for almost a year. His new company allows employees to participate in its health plan at the end of the first pay period. Mike has mild asthma. In the six months prior to the time he enrolled in his employer’s health plan, he had no doctor visits and did not take any medication. He was not subject, therefore, to any exclusion period for his pre-existing conditions. Shortly after he started working, his asthma worsened – he was fully covered for all of his asthma-related care.

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