What counts as a pre-existing condition?
Insurers commonly define a pre-existing condition as a disease, illness, symptom or injury that existed before the policy start date, whether or not formally diagnosed. Each insurer’s definition is different, and some conditions or medications may be excluded entirely.
What does medically stable mean?
A stable-condition benefit generally requires the medical condition to remain within the policy’s specified stability criteria for a stated period before coverage starts. Policy definitions may consider changes in medication, symptoms, treatment, test results, hospitalization or new referrals. Merely feeling well does not necessarily satisfy the stability definition.
Questions worth answering before buying
- Has the condition been diagnosed, investigated or treated?
- Have medications or dosages changed during the applicable stability period?
- Has a physician recommended further testing, specialist evaluation or treatment?
- Does the insurer offer a plan that explicitly includes qualifying stable conditions?
- Are there age-based limitations or exclusions?
Claims and disclosure
A claim can be denied when it falls within an excluded pre-existing condition or the stability test is not met. Answer health questions accurately and keep relevant treatment information. Emergency assistance often needs to be contacted promptly according to the policy.