Pre-existing Condition

Definition

• 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.

Synonyms
pre-existing illness, pre-diagnosed condition

Acronyms
PRE-X

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.