A&H Policy ProvisionsQuestion 344 of 716

A 'pre-existing condition' provision in a health policy generally allows the insurer to:

a.Limit or exclude coverage for a condition the insured had before the policy took effect, for a stated period
b.Refuse to ever pay for accidents, including injuries that occur long after the policy took effect
c.Increase the death benefit payable for illnesses the insured was treated for before applying
d.Cancel the policy outright whenever the insured files any claim, regardless of when the condition first arose

Explanation

A pre-existing condition provision lets the insurer limit or exclude benefits for a medical condition that existed (was diagnosed or treated, or would have prompted a prudent person to seek care) before the policy's effective date, typically for a defined waiting period after which the condition is covered. It is not a general right to cancel the policy whenever a claim is filed, and it does not let the insurer refuse all accident coverage. Health policies pay medical or disability benefits, not a death benefit, so raising a death benefit for previously treated illnesses is inapplicable.

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PrepPass team · Verified against California Life & Health Insurance License Exam · How we review
Reviewed by John Zihao Zhang — California-Licensed Life Insurance Agent (CA Dept. of Insurance License #4396095 — verify)
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