Pre-Existing Conditions


In the context of healthcare, a pre-existing condition is a medical condition that started before a person’s health insurance went into effect. Some insurance policies do not cover expenses due to pre-existing conditions or require a waiting period before such expenses can be covered.




In general terms, a pre-existing condition is a “medical condition that occurred before a program of health benefits went into effect. These Conditions can sometimes be broken down into two further categories and most insurance companies use both or one of two definitions to identify such conditions.

Objective standard definition: a pre-existing condition is any condition for which the patient has already received medical advice or treatment prior to enrollment in a new medical insurance plan.

Prudent person definition: a pre-existing condition is anything for which symptoms were present and a prudent person would have sought treatment.

Which definition may be used is may vary from one insurance company to another. Please seek clarification from your insurance service specialist or contact your insurance service provider


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