Merritt Personal Lines Manual: Chapter 4 Preexisting Conditions

As we have mentioned previously, preexisting conditions are an important issue to look into when shopping for health insurance. Why? Limits on preexisting conditions are usually the most common issue in health insurance coverage disputes.

Most plans don't cover preexisting conditions during the six months following the effective date of coverage or any disease or physical condition named or specifically described as excluded in any endorsement attached to this policy.

Pay close attention to any talk of specific or custom exclusions on any policy. This holds especially true if you've had any notable illness or disability in the last ten years -- even if it's healed or in remission.

An example: When you applied for insurance, you disclosed that you'd been treated for a heart condition during the past two years. If the insurance company doesn't attach a specific exclusion, you would have coverage for the heart condition -- but only after a waiting period. If the heart condition is excluded, you will never have coverage for that condition, regardless of how long the policy is in effect.

While some states are moving toward cost containment, others have moved in the opposite direction -- stressing what they call "consumer choice."