A pre-existing condition is a medical condition that a person has before applying for health insurance. The condition must have been treated by a doctor and recorded in the medical history of the patient to qualify as a pre-existing condition. According to HealthReform.gov, a pre-existing condition can be a major or minor illness, ranging from cancer to asthma, depending on state laws and various insurance company rules. As of 2009, 45 states allow insurance companies to refuse coverage for pre-existing conditions.
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HealthReform.gov reports that one in 10 patients with cancer could not find adequate health insurance coverage. Some insurance companies deny coverage for anyone who has ever had cancer, while others only look back for the past 20 years. Individual health plans that require a physical to qualify for insurance often deny coverage to patients with cancer, report consultants at the American Cancer Society. Coverage through group plans offered by employers often require those with cancer to wait up to 18 months before cancer-related services are covered under their pre-existing clauses.
Nine states allow insurance companies to refuse coverage to anyone who has a history of domestic violence injuries. According to the Service Employees International Union, victims of domestic violence were considered high risk and either denied coverage or charged additional rates for health insurance coverage by eight of the 16 largest insurance companies in the United States.
Diabetes is a common illness that often disqualifies patients from purchasing individual health insurance. While group plans cannot deny coverage for any reason, they can withhold benefits for a period of time for certain conditions like diabetes. Some insurance companies offer riders that individuals can purchase to cover diabetes care, while others may provide coverage for any other health issue and exclude coverage for diabetes-related illnesses.
Most insurance companies turn down applicants who are pregnant. As long as an applicant is not pregnant when the coverage first begins, there typically is not a waiting period for when pregnancy coverage will begin. Others refuse pregnancy coverage for one year after the start-date of the policy.
Other Common Exclusions
According to the Lehman Group, a company that brokers health insurance plans, most insurance companies will turn down any applicant who has been treated for alcoholism or drug addiction. If the applicant has had a heart attack within five years of applying for coverage, the policy is usually denied. AIDS is almost always an automatic pre-existing turndown for health coverage. High blood pressure and high cholesterol by themselves are not usually considered pre-existing conditions, but if both are present, many insurance companies will refuse coverage.