The term “pre existing conditions”, relative to the insurance industry is seen mostly in hospitalization, individual and group coverages, health and accident policies, disability policies and to a lesser extent, life insurance. Intuitively most seem to understand the term to mean stuff–illness, injuries and conditions which you had before you applied for the policy.
However, the actual policy you own or that you may be considering right now has the actual definition to which you and or your family will be subject to.
A typical definition of pre existing conditions can be found in a provision entitled: “Pre existing Conditions”and might read as:
A pre existing condition is one which firsts manifests itself, or one that you have been treated for, advised of and or received a prescription for during the immediate 24 month period prior to completing this application for insurance. These conditions shall no longer be considered a pre existing condition after a period of 6 consecutive months of being free of any treatment or medications for such conditions, or 12 consecutive months of insured coverage under this policy, whichever occurs first. Just for the record, manifests itself means when did the condition first become noticeable.
It is important to understand this provision if you have any pre existing conditions, because your policy may exclude or reduce coverage on pre existing conditions. If you understand how they will or will not be covered you will minimize, frustration, headaches and wasted time with the claims department.
Also, keep in mind some policies have a provision in the policy called “Time Limit on Certain Defenses” or “Incontestability”. While they sound about the same they are dramatically different. Time Limit on Certain Defenses states: After the policy has been in force for a period of 24 consecutive months no statement or mi statement made in the application, except fraudulent statements will be used to deny a claim.” This lets the insured know that after two years, unless the insured out right lied or committed fraud, all claims will be paid, even if a condition was discovered that would have prevented the policy from being issued. This is the minimum required provision in health and accident insurance.
The more liberal approach is the Incontestability provision it states: “After the policy has been in force for a period of 24 consecutive months no statement or misstatement made in the application shall be used to deny a claim.” This provision is more liberal in that for all practical purposes after the policy has been in force for 2 years they can not deny a claim–period.
I am always available to answer any questions you might have, email me at: [email protected] Also, you will find that the Insurance Department has a wealth of information, all available to you at no charge.