What is a 'pre-existing condition'?

A pre-existing condition refers to a health issue or medical condition that an individual has prior to applying for and obtaining health insurance coverage. Insurance companies often assess these conditions when determining the terms of coverage, as they may affect the risk of insuring the individual.

When someone applies for health insurance, the insurer may review the applicant's medical history and any conditions that were diagnosed or treated before the application date. Because these conditions may require ongoing treatment or management, insurers may impose specific terms related to coverage, waiting periods, or even exclusions for these conditions in the policy.

This definition clarifies why pre-existing conditions are a crucial aspect of health insurance policies, influencing coverage options and premium costs. Understanding this concept is fundamental when navigating insurance plans, as it affects the availability of benefits for specific health needs at the time the policy is initiated.