Health Insurance Quotes
Ask the Health Insurance Expert
If I had a health condition but didn't know it, can it still be considered a "pre-existing" condition?
No, a pre-existing condition is a health condition for which you sought treatment before the insurance policy went into effect. If you didn't know of the condition and were never treated for it, then the condition should not be considered pre-existing.
That doesn't mean, however, that disputes don't arise between health insurers and policyholders over whether a condition was pre-existing. Contact your state insurance department if you think a health insurance company has wrongly denied a claim as pre-existing and you're unable to get anywhere through company channels.
Group health insurance through employers covers pre-existing conditions, as long as the patient had health insurance for 12 months before enrolling in the plan with no coverage gaps of 63 days or more.
Insurance companies offering individual health insurance, though, are not required to cover pre-existing conditions, regardless of whether the patient had health insurance in place prior to the effective date of the policy.
Under the new health reform law, health insurance plans sold through state insurance exchanges -- marketplaces where consumers will buy individual insurance -- must cover pre-existing conditions starting in 2014. The new federal law already prohibits insurers from denying coverage for children's pre-existing conditions.
Meanwhile, the federal government and states offer health insurance, through high-risk insurance pools, to people who can't otherwise get coverage and have been without health insurance for at least six months.
For more, see What is a pre-existing condition, exactly?