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What Do You Mean It's Not Covered: Specific Limits on Preexisting Conditions

PREEXISTING CONDITION LIMITATIONS -- You do not have any coverage for: (1) preexisting conditions during the six months following the effective date of coverage as to an insured person; or (2) any disease or physical condition named or specifically described as excluded in any endorsement attached to this policy.

This is probably the most common issue in health insurance coverage disputes. The policy does not cover preexisting conditions during the first two years after coverage takes effect for any insured, nor does it cover any condition specifically excluded by an attached endorsement. 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, your coverage for the heart condition would begin two years after the policy has been in effect. If the heart condition is excluded by endorsement, you would never have coverage for that condition, regardless of how long your coverage is in effect. A caveat: 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 on the last ten years -- even if it's healed or in remission. In 1991, Citizens Fund issued a report, "The Seven Warning Signs: Health Insurance at Risk" which determined that there are 81 million people under the age of 65 who have health care problems that could result in their facing specific exclusions. Another consumer group found that some insurers refuse to cover people with medical conditions as common as diabetes, asthma, chronic headaches and allergies.

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