- A medical condition that predates the writing of an insurance policy. Many health insurance policies do not cover pre-existing conditions. There are two main definitions of a pre-existing condition used by insurance companies: the "objective standard" definition and the "prudent person" definition. Under the "objective standard" definition, a pre-existing condition is a medical condition for which a patient has previously received advice, a diagnosis, or treatment. A pre-existing condition under the "prudent person" definition is a medical condition for which symptoms were present and a prudent person would have sought treatment.
pre-existing illness, pre-diagnosed condition
Related Terms and Acronyms
- Case Management — Definition,
- A system where medical services and patient treatments are coordinated by a case manager.
- Clean Sheeting — Definition,
- A type of insurance fraud where an individual deliberately fails to disclose a pre-existing condition in order to receive coverage, sometimes with the help of an insurance broker.
- Exclusions — Definition,
- Situations, as listed in an insurance policy, where insurance companies are allowed to deny coverage to policyholders.
- Health Insurance (HI) — Acronym,
- Insurance that covers the costs of medical expenses for insured persons.
- Insurance Fraud — Definition,
- An illegal attempt by an individual or entity to receive insurance benefits that they would otherwise not be entitled to or for an insurance company to deny a legitimate insurance claim.
- Least Expensive Alternative Treatment (LEAT) — Acronym,
- When multiple treatment options exist for the same illness, insurers are only obligated to provide the most cost effective treatment.
- Morbidity Rate — Definition,
- A measurement of how prevalent a medical condition or disease is.
- Usual, Customary and Reasonable Fees — Definition,
- The expected cost of a medical treatment, and what an insurance company is willing to pay.
- Without Evidence of Insurability — Definition,
- Applying for insurance coverage without the insurer requiring the individual to take a medical examination.