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What qualifies as a "pre-existing condition" for medical insurance?

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melbalalala
Little Lady

Member since 5/07

5014 total posts

Name:
Melissa

What qualifies as a "pre-existing condition" for medical insurance?

My brother has had problems with his back for over a year now. He finally got health insurance this month and wants to get to a Dr. ASAP about it.

Does he have to "fib" and pretend that the back pain is new? Will insurance not cover it if they knew he had it for awhile?

Or is that just a concern with a long-term illness?

TIA! Chat Icon

Posted 8/14/07 1:28 PM
 
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J9-13
We're gonna be big sisters!

Member since 6/06

14887 total posts

Name:
J9

Re: What qualifies as a "pre-existing condition" for medical insurance?

I think that would be for a long term illness that he was previously being treated for.

Posted 8/14/07 1:30 PM
 

nrthshgrl
It goes fast. Pay attention.

Member since 7/05

57538 total posts

Name:

Re: What qualifies as a "pre-existing condition" for medical insurance?

http://www.ins.state.ny.us/faqcs1.htm
Ans: A pre-existing condition is any condition for which a person received treatment or treatment was recommended within the preceding six months.
Any individual enrolling in a new health plan covered by NYS law may be subject to up to a 12 month waiting period (six months for Medicare Supplement policy holders) before expenses related to the pre-existing condition are covered. However, the plan must subtract from the waiting period the time that the person had continuous coverage in a previous plan. Continuous coverage means that the person had less than a sixty three day gap between coverages. The insurer shall count a period of creditable coverage for all benefits or may elect to credit coverage based on Categories of Benefits specified in the policy or certificate.

Posted 8/14/07 2:06 PM
 

melbalalala
Little Lady

Member since 5/07

5014 total posts

Name:
Melissa

Re: What qualifies as a "pre-existing condition" for medical insurance?

Posted by nrthshgrl

http://www.ins.state.ny.us/faqcs1.htm
Ans: A pre-existing condition is any condition for which a person received treatment or treatment was recommended within the preceding six months.
Any individual enrolling in a new health plan covered by NYS law may be subject to up to a 12 month waiting period (six months for Medicare Supplement policy holders) before expenses related to the pre-existing condition are covered. However, the plan must subtract from the waiting period the time that the person had continuous coverage in a previous plan. Continuous coverage means that the person had less than a sixty three day gap between coverages. The insurer shall count a period of creditable coverage for all benefits or may elect to credit coverage based on Categories of Benefits specified in the policy or certificate.



Thanks!

Posted 8/14/07 2:19 PM
 
 

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