What is a pre-existing condition in relation to health insurance?

Dr. Michael Roizen, MD
Internal Medicine
From a health insurance standpoint, a pre-existing condition is a health problem you have been diagnosed with, advised about, or given treatment for prior to enrolling in a new health insurance plan.

A preexisting condition is any physical or mental condition that you may be diagnosed with prior to obtaining health insurance from a specific insurance provider. Some examples of preexisting conditions are pregnancy, diabetes, depression, and fibromyalgia. Most companies will provide coverage to someone with a preexisting condition at a higher rate. If your insurance is provided through your employer in a large group plan, a preexisting condition should not affect your coverage. If you need to change your coverage, you may be able to purchase a COBRA policy. COBRA stands for the Consolidation Omnibus Budget Reconciliation Act, which gives you the right to continue coverage for a limited time when you lose a job or experience a reduction of hours leading to loss of coverage.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.