Insurance Provider Pre-Existing Health Conditions Rules

Insurance providers have different rules and regulations when it comes to coverage of pre-existing conditions. Having a pre-existing condition merely means that a health condition existed prior to your personal health insurance policy. Many times, insurance companies can still cover pre-existing conditions, after meeting a few general rules. It is important to understand what qualifies as a pre-existing condition, what conditions must be met before being accepted into the plan and what conditions make finding coverage nearly impossible.


Each company defines pre-existing condition differently, but for the most part, it is an injury or illness, which was present or has manifested itself before applying to the plan. These conditions could range from type II diabetes to pregnancy and even obesity. Having a pre-existing condition does not exclude you automatically from a plan, but there may be some stipulations, which need to be met before you can be accepted into a policy.

Some of those stipulations are a waiting period before the company will pick up any portion of the bills for that specific condition or even making sure that you have not had a significant break in insurance coverage, usually less than 63 days.

Waiting periods ensure insurance companies have enough time to build up funds in your account, so they are better equipped to cover any costs that might be incurred. These waiting periods can be anywhere from three months to a year and are usually set based on the type of pre-existing condition you have.

If you have anything you think qualifies as a pre-existing condition, ask the insurance company if they consider it as such, and what their waiting period is. For people with pre-existing conditions, usually the smaller waiting period plays a bigger role in choosing a plan.

Some pre-existing conditions, like heart disease, cancer and some forms of diabetes can make it extremely difficult to get personal health insurance all together. For many, COBRA insurance is the best plan for pre-existing conditions; however, COBRA insurance is not always an option. In the case you find yourself pricing personal health insurance with a pre-existing condition, it is always a good idea to speak with a health insurance representative who can help point you to insurance companies that will work with pre-existing conditions.

Having a pre-existing condition does not make it a lost cause trying to find good individual health insurance; on the contrary, this is the time to really ask the hard-hitting questions to the different companies to see who is truly serious about helping you get the care you need at a price you can afford. Finding the best plan to suit you does not need to be difficult if you have a pre-existing condition, but it will take some patience and some dedication to figuring out which company holds the best policy to meet your individualized needs.

Getting in touch with a local insurance representative is a great place to start on the road to purchasing individual health insurance. Look for a representative who has the heart of a teacher, and doesn’t mind going slow, explaining what everything means. These will be the individuals who can lead you to the best plans to help cover your immediate needs.

Insurance Provider Pre-Existing Health Conditions Rules

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