Health Insurance What is a pre-existing condition, exactly? Written by Leah Shepherd | Reviewed by Michelle Megna Michelle Megna Michelle, the former editorial director, insurance, at QuinStreet, is a writer, editor and expert on car insurance and personal finance. Prior to joining QuinStreet, she reported and edited articles on technology, lifestyle, education and government for magazines, websites and major newspapers, including the New York Daily News. | Posted on: November 23, 2010 Why you can trust Insure.com Quality Verified At Insure.com, we are committed to providing the timely, accurate and expert information consumers need to make smart insurance decisions. All our content is written and reviewed by industry professionals and insurance experts. Our team carefully vets our rate data to ensure we only provide reliable and up-to-date insurance pricing. We follow the highest editorial standards. Our content is based solely on objective research and data gathering. We maintain strict editorial independence to ensure unbiased coverage of the insurance industry. If you’re choosing a health insurance plan, you need to know how it will handle pre-existing conditions. The new health care reform law will prohibit insurers from denying coverage for pre-existing conditions in 2014, but until then the old rules stand for adults. (Children’s pre-existing conditions must be covered.) A pre-existing condition is a health condition that was treated prior to the effective date of a new insurance policy. The term does not apply to a condition that the patient was not aware of and did not seek treatment for, according to Jackie Aube, vice president of product for the health insurer CIGNA. Pre-existing conditions in group health insurance In group health insurance plans (the type offered by employers), pre-existing conditions are covered as long as the patient had health insurance coverage for the 12 months prior to enrolling in a new plan, with no coverage gaps of 63 days or more, Aube says. If there was a coverage gap, then pre-existing condition exclusions can apply to your group health plan, according to the federal HIPAA law. A group health plan may deny coverage for a pre-existing condition for a specified amount of time — usually 12 months. After that exclusion period is over, the condition will be covered. To define “pre-existing,” insurers usually look back three to 12 months before the effective date of the policy. That’s called the “look-back period.” For example, if you were treated for eczema three years ago and haven’t sought treatment for it since then, it would not be considered a pre-existing condition. Pre-existing conditions in individual health insurance For those with individual health insurance, pre-existing conditions often are not covered, regardless of how long you had previous coverage or whether there was a coverage gap. Health insurance quotes can be very high for individual plans if you have a pre-existing condition. Pre-existing condition insurance plans In July, the U.S. Department of Health and Human Services announced Pre-existing Condition Insurance Plans, which covers adults who are unable to obtain individual health insurance due to a pre-existing condition. It’s a transitional program slated to end in 2014, when health insurance exchanges will take their place. “For too long, Americans with pre-existing conditions have been locked out of our health insurance market,” says HHS Secretary Kathleen Sebelius. “This program will provide people the help they need as the nation transitions to a more competitive and fair market place in 2014.” Related Articles Can you decline the health insurance plan at work? By Erik Martin How does primary and secondary health insurance work? By Chris Kissell How to get health insurance if you’re unemployed or changing jobs By Shivani Gite How much does COBRA insurance cost? By Les Masterson A complete guide to short-term health insurance By Shivani Gite A guide to understanding your health insurance policy By Mark Vallet ZIP Code Please enter valid ZIP See rates