About Chronic And Pre-existing Conditions - Freedom Health Insurance (2024)

FAQs

What are pre-existing and chronic conditions? ›

A medical illness or injury that you have before you start a new health care plan may be considered a pre-existing condition. Conditions like diabetes, chronic obstructive pulmonary disease (COPD), cancer, and sleep apnea, may be examples of pre-existing health conditions. They tend to be chronic or long-term.

Health insurance companies cannot refuse coverage or charge you more just because you have a “pre-existing condition” — that is, a health problem you had before the date that new health coverage starts.

What are pre-existing medical conditions? A pre-existing medical condition (PEMC) is an illness or injury you had before your policy began or was renewed. Examples of pre-existing medical conditions include, diabetes, asthma, high cholesterol or a long-term back condition.

Chronic disease management programs are covered by plans sold on the Marketplace, in the individual market, and through small employers. They are part of the essential health benefits the Affordable Care Act requires health plans to cover. Many health plans from large companies also help pay for these programs.

The most common types of chronic disease are cancer, heart disease, stroke, diabetes, and arthritis.

Under the Affordable Care Act, health insurance companies can't refuse to cover you or charge you more just because you have a “pre-existing condition” — that is, a health problem you had before the date that new health coverage starts.

While insurers generally determine the presence of a pre-existing condition based on an applicant's current health status, sometimes a healthy applicant can be deemed to have a pre-existing condition based on a past health problem or evidence of treatment for a particular condition.

The time period during which a health plan won't pay for care relating to a pre-existing condition. Under a job-based plan, this cannot exceed 12 months for a regular enrollee or 18 months for a late-enrollee.

A pre-existing medical condition is a disease, illness or injury for which you have received medication, advice or treatment or had any symptoms (whether the condition has been diagnosed or not) in the five years before your joining date. Health insurance doesn't usually cover 'pre-existing conditions'.

What is the time frame for pre-existing conditions? ›

If you are joining a fully insured group health plan in California, the maximum exclusion period is 6 months. If you are joining a self-insured group health plan, the maximum exclusion period is 12 months. You will receive credit toward your pre-existing condition exclusion period for any previous continuous coverage.

A health problem, like asthma, diabetes, or cancer, you had before the date that new health coverage starts. Insurance companies can't refuse to cover treatment for your pre-existing condition or charge you more.

If you travel frequently and are more likely to need care while away from home, especially if you are living with a chronic condition or enjoy high-risk hobbies such as certain sports, you may need a PPO to provide the best coverage for your needs.

Chronic diseases are defined broadly as conditions that last 1 year or more and require ongoing medical attention or limit activities of daily living or both.

a human health condition or disease that is persistent or otherwise long-lasting in its effects or a disease that comes with time. The term chronic is often applied when the course of the disease lasts for more than three months.

An illness or injury experienced before enrollment in a health insurance plan may be considered a pre-existing condition. Pre-existing conditions can include health issues such as cancer, diabetes, lupus, depression, acne, pregnancy, or just about any other health condition you can imagine.

A serious pre-existing condition is one that may require intensive medical intervention to treat or manage; or have high risk of future complications or recurrence, and therefore may require prolonged treatment.

In insurance terms, a chronic illness is usually defined as a permanent condition that inhibits you from performing at least two of the six basic "activities of daily living": Ambulating. Continence. Feeding.

Examples of pre-existing conditions

Here are a few examples of conditions that may be considered as pre-existing by your insurer: Chronic pain such as back pain, neck pain… Cardiovascular conditions such as hypertension, high cholesterol... Cancers.