Pre-existing Condition

Any illness or health condition for which you have received medical advice or treatment during the six months prior to obtaining health insurance. Group healthcare policies cover pre-existing conditions after you have been insured for six months, and individual policies cover pre-existing conditions after you have been insured for one year. Reference CIC Section 10198.7. Creditable coverage must be counted towards any pre-existing condition exclusion in either an individual or group policy.

If you have experienced an illness or disability for which you have been diagnosed, treated or advised, that is considered a “pre-existing condition.” When you apply for an individual health insurance policy, you will be asked to describe any pre-existing conditions or previous treatment. The health insurance carrier may decide to offer you health coverage with an “exclusion” for the specific condition, even if you are not currently experiencing problems. This means the carrier will not cover any medical treatment for the excluded condition. Failing to mention a pre-existing condition for which you have previously sought medical advice is a reason for the carrier to rescind or cancel your policy at a later date. It is always advisable to provide a full and complete medical history.

A health problem you had before the date that new health coverage starts.

A pre-existing condition is a health problem that you already have when you apply for insurance.

If you have a pre-existing condition, an insurer can refuse to cover treatment connected to that problem for a period of time. That period is often the first six months, but may be for the entire term of your policy.

Insurers can also deny you coverage entirely because of a pre-existing condition. And they can end a policy if they discover a pre-existing condition that you did not report, provided you knew it existed when you applied for your policy.

However, if you're insured through your employer's plan and switch to a job that also provides health insurance, the new plan must cover you regardless of a pre-existing condition.