Legal Definitions - preexisting condition

A preexisting condition refers to any health problem, medical issue, or physical ailment that an individual had or was diagnosed with before the effective start date of a new health insurance policy or other type of insurance coverage.

Here are some examples to illustrate this concept:

• Health Insurance Context: Imagine Sarah has been managing asthma for several years. When she starts a new job, she enrolls in her employer's health insurance plan. For this new insurance plan, Sarah's asthma would be considered a preexisting condition because it was a known medical issue she had before her coverage with this specific plan began. Under current law in the United States, health insurance companies cannot deny coverage or charge more based on preexisting conditions, but the term itself still describes the timing of the condition relative to the policy start date.

• Travel Insurance Context: John plans a vacation abroad and purchases travel insurance. A few months before buying the policy, he had a minor heart procedure and is now fully recovered. If his travel insurance policy includes clauses about preexisting conditions, his past heart procedure might be considered a preexisting condition. This could mean that if he were to experience a related heart issue during his trip, the travel insurance might not cover the costs unless he specifically declared it and paid an additional premium, or if the policy has a specific look-back period for such conditions.

• Disability Insurance Context: Maria suffered a serious knee injury playing sports a year ago, which occasionally flares up and prevents her from working. She then decides to purchase a long-term disability insurance policy. Her knee injury, and any related complications, would be a preexisting condition for this new disability policy. Depending on the terms of her policy, benefits related to this specific injury might be excluded for a certain period or entirely, as the condition existed before her coverage for potential disability began.